Organization
SOUTH CENTRAL REGIONAL MEDICAL CENTER
Active
Other names
South Central Extended Care Facility
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES T CANIZARO (CFO)
(601) 426-4504
Entity
Organization
Contact information
Practice address
305 E IVY ST, ELLISVILLE, MS 39437-2746
(601) 477-9381
(601) 477-9870
Mailing address
PO BOX 607, LAUREL, MS 39441-0607
(601) 399-6103
(601) 399-6254
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
11153
MS
Other
Enumeration date
06/24/2005
Last updated
11/16/2007
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