# PHC-CLEVELAND LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bolivar Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770889461
- **Authorized official:** JOHNETTA TRAYLOR PESC (DIRECTOR)
- **Authorized official phone:** (502) 596-6063

## Contact information

- **Practice address:** 901 E SUNFLOWER RD, CLEVELAND, MS 38732-2833
- **Practice address phone:** (662) 846-0061
- **Practice address fax:** (662) 846-2380
- **Mailing address:** 680 S 4TH ST, LOUISVILLE, KY 40202-2407
- **Mailing address fax:** (502) 212-8481

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 275N00000X | Medicare Defined Swing Bed Hospital Unit | — | NULL | Yes |

## Other

- **Enumeration date:** 01/28/2011
- **Last updated:** 06/10/2025