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General NPI Number Information
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NPI Number | 1609259936
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Entity Type | Organization
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Legal Business Name | MERIDIAN PEDIATRIC EXTENDED CARE LLC
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Dates
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Enumeration Date | 07/06/2015
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Last Update Date | 07/06/2015
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Provider Practice Location Address
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Address Line | 3850 HIGHWAY 45 N
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City | MERIDIAN
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State | MS
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Zip | 39301-1517
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Country | US
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Telephone | 601-912-0373
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Fax | 601-910-7521
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Provider Business Mailing Address
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Address Line | 3850 HIGHWAY 45 N
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City | MERIDIAN
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State | MS
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Zip | 39301-1517
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Country | US
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Telephone | 601-912-0373
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Fax | 601-910-7521
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ASHLEY HAMMOND
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Credential | RPH
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Telephone | 601-912-0373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number |
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License Number State |
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