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General NPI Number Information
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NPI Number | 1609866235
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Entity Type | Organization
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Legal Business Name | KEMPER COUNTY LTC INC
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Dates
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Enumeration Date | 10/25/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 220 WILLOW AVE
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City | DEKALB
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State | MS
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Zip | 39328-0577
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Country | US
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Telephone | 601-743-5888
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Fax | 601-743-4506
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Provider Business Mailing Address
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Address Line | PO BOX 577
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City | DE KALB
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State | MS
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Zip | 39328-0577
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Country | US
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Telephone | 601-743-5888
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Fax | 601-743-4506
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. PATTY C NESTER
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Credential | NHA
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Telephone | 601-743-5888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 358
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License Number State | MS
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