MEDICARE: QUEEN CITY NURSING CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	219	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093702144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEEN CITY NURSING CENTER INC

Provider Business Mailing Address
First Line	:	1201 28TH AVE
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39301-3810
Country	:	US
Telephone Number	:	601-483-1467
Fax Number	:	601-483-1483

Provider Business Practice Location Address
First Line	:	1201 28TH AVE
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39301-3810
Country	:	US
Telephone Number	:	601-483-1467
Fax Number	:	601-483-1483

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. BARBARA HOWARD
Credential	:
Telephone Number	:	601-483-1467

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	08/22/2020

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Directions to “QUEEN CITY NURSING CENTER INC ” Practice Location

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