Organization
MONTICELLO COMMUNITY CARE CENTER LLC
Active
Other names
Lawrence County Nursing Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TONI PARKISON (AUTHORIZED REPRESENTATIVE)
(601) 709-1408
Entity
Organization
Contact information
Practice address
700 JEFFERSON ST., MONTICELLO, MS 39654-0398
(601) 587-2593
(601) 587-5352
Mailing address
700 JEFFERSON ST., MONTICELLO, MS 39654-0398
(601) 587-2593
(601) 587-5352
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
459
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00230110
—
MS
01
—
80541
BLUE CROSS BLUE SHIELD
MS
Enumeration date
05/05/2006
Last updated
04/30/2013
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