MEDICARE: STATE VETERANS AFFAIRS BOARD

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

General Provider Information

NPI Number	:	1982811642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE VETERANS AFFAIRS BOARD

Provider Business Mailing Address
First Line	:	PO BOX 3439
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39207-3439
Country	:	US
Telephone Number	:	601-576-4859
Fax Number	:	601-576-4868

Provider Business Practice Location Address
First Line	:	660 NORTH ST
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39202-3141
Country	:	US
Telephone Number	:	601-576-4859
Fax Number	:	601-576-4868

Authorized Official
Title or Position	:	CFO
Name	:	DEMETRICE WATTS
Credential	:
Telephone Number	:	601-576-4859

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	11/10/2022

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Directions to “STATE VETERANS AFFAIRS BOARD ” Practice Location

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