MEDICARE: CALHOUN HEALTH SERVICES NURSING HOME

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	313M00000X	Nursing Facility/Intermediate Care Facility	1084	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	:	1093811903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALHOUN HEALTH SERVICES NURSING HOME

Provider Business Mailing Address
First Line	:	152 BURKE CALHOUN CITY RD
Second Line	:
City	:	CALHOUN CITY
State	:	MS
Zip	:	38916
Country	:	US
Telephone Number	:	662-628-6611
Fax Number	:	662-628-5707

Provider Business Practice Location Address
First Line	:	152 BURKE CALHOUN CITY RD
Second Line	:
City	:	CALHOUN CITY
State	:	MS
Zip	:	38916
Country	:	US
Telephone Number	:	662-628-6611
Fax Number	:	662-628-5707

Authorized Official
Title or Position	:	DIRECTOR OF FISCAL SERVICES
Name	:	MANDY SUBER
Credential	:
Telephone Number	:	662-628-6611

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	08/22/2020

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