Organization
MID-DELTA PROPERTIES LLC
Active
Other names
Washington Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TONI PARKINSON (AUTHORIZED REPRESENTATIVE)
(601) 709-1408
Entity
Organization
Contact information
Practice address
1920 LISA DRIVE EXT, GREENVILLE, MS 38703-4408
(662) 335-2897
(662) 335-2130
Mailing address
1920 LISA DRIVE EXT, GREENVILLE, MS 38703-4408
(662) 335-2897
(662) 335-2130
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
989
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04003561
—
MS
01
—
80454
BLUE CROSS BLUE SHIELD
MS
Enumeration date
12/31/2007
Last updated
04/30/2013
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