Organization
MADISON COMMUNITY CARE CENTER LLC
Active
Other names
Highland Home
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TONI PARKINSON (AUTHORIZED REPRESENTATIVE)
(601) 709-1408
Entity
Organization
Contact information
Practice address
638 HIGHLAND COLONY PKWY, RIDGELAND, MS 39157-8724
(601) 853-0415
(601) 853-0515
Mailing address
638 HIGHLAND COLONY PKWY, RIDGELAND, MS 39157-8724
(601) 853-0415
(601) 853-0515
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
934
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000080391
BLUE CROSS BLUE SHIELD MS
MS
05
—
00230169
—
MS
Enumeration date
05/04/2006
Last updated
04/30/2013
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