MEDICARE: 538 MENGE AVENUE OPERATIONS, LLC

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

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	:	1124776232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	538 MENGE AVENUE OPERATIONS, LLC

Provider Business Mailing Address
First Line	:	538 MENGE AVE
Second Line	:
City	:	PASS CHRISTIAN
State	:	MS
Zip	:	39571-4234
Country	:	US
Telephone Number	:	228-452-4344
Fax Number	:	228-452-2264

Provider Business Practice Location Address
First Line	:	538 MENGE AVE
Second Line	:
City	:	PASS CHRISTIAN
State	:	MS
Zip	:	39571-4234
Country	:	US
Telephone Number	:	228-452-4344
Fax Number	:	228-452-2264

Authorized Official
Title or Position	:	MANAGER
Name	:	TIM LEHNER
Credential	:
Telephone Number	:	770-698-9040

Provider Enumeration Date	:	03/17/2022
Last Update Date	:	09/13/2024

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