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General NPI Number Information
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NPI Number | 1811256977
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Entity Type | Organization
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Legal Business Name | ACADEMY HEALTH CENTER,INC.
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Dates
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Enumeration Date | 05/10/2012
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Last Update Date | 05/10/2012
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Provider Practice Location Address
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Address Line | 6428 U S HIGHWAY 11
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City | LUMBERTON
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State | MS
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Zip | 39455-7524
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Country | US
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Telephone | 601-794-8566
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Fax |
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Provider Business Mailing Address
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Address Line | 6428 US HIGHWAY 11
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City | LUMBERTON
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State | MS
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Zip | 39455-7524
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AHC, IN
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Name | MR. ROGER W BURKE
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Credential |
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Telephone | 601-917-2697
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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 | 351
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License Number State | MS
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