Basic Information
| Provider Information | |||||||||
| NPI: | 1891938049 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HATTIESBURG HEALTH & REHAB CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13 NORTHTOWN DR | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392113047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019568276 | ||||||||
| FaxNumber: | 6017090832 | ||||||||
| Practice Location | |||||||||
| Address1: | 514 BAY ST | ||||||||
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| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394013933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6015444230 | ||||||||
| FaxNumber: | 6015822480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2009 | ||||||||
| LastUpdateDate: | 04/16/2009 | ||||||||
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| AuthorizedOfficialLastName: | DELANEY | ||||||||
| AuthorizedOfficialFirstName: | ROYCE | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 6019568276 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | MS | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.