Organization
MISSISSIPPI BAND OF CHOCTAW INDIANS
Active
Other names
Choctaw Residential Center Enterprise
Organization subpart
No
Provider details
NPI number
Authorized official
MS. WENDY MICHELLE MORAN (NURSING HOME ADMINISTRATOR)
(601) 656-2582
Entity
Organization
Contact information
Practice address
135 HOSPITAL CIR, CHOCTAW, MS 39350-6780
(601) 656-2582
Mailing address
135 HOSPITAL CIR, CHOCTAW, MS 39350-6780
(601) 656-2582
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
583
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00023031
—
MS
01
—
25-5339
MEDICARE CCN
MS
Enumeration date
05/05/2006
Last updated
11/06/2013
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