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General NPI Number Information
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NPI Number | 1831371210
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Entity Type | Organization
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Legal Business Name | BEDFORD ALZHEIMERS CARE CENTER, LLC
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | 300 CAHAL ST SUITE B
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City | HATTIESBURG
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State | MS
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Zip | 39401-2922
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Country | US
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Telephone | 601-582-9157
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Fax | 601-582-2639
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Provider Business Mailing Address
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Address Line | 300 CAHAL ST
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City | HATTIESBURG
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State | MS
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Zip | 39401-2922
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Country | US
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Telephone | 601-582-9157
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Fax | 601-582-2639
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JACK A BEVON, III
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Credential |
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Telephone | 601-582-9157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 1008
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License Number State | MS
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