MEDICARE: WCRL, 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	926	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	:	1780758904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WCRL, LLC

Provider Business Mailing Address
First Line	:	PO BOX 2712
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39158-2712
Country	:	US
Telephone Number	:	601-853-2667
Fax Number	:	601-853-2116

Provider Business Practice Location Address
First Line	:	49 WILLOW CREEK LN
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39272-9255
Country	:	US
Telephone Number	:	601-863-4201
Fax Number	:	601-863-4202

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. DAVID ROTOLO
Credential	:
Telephone Number	:	601-853-2667

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	02/20/2008

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Directions to “WCRL, LLC ” Practice Location

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