Organization
JEFFERSON COUNTY NURSING HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MONTINA FLETCHER BOLTON (ADMINISTRATOR)
(601) 786-3888
Entity
Organization
Contact information
Practice address
910 MAIN ST, FAYETTE, MS 39069-5524
(601) 786-3888
(601) 786-9400
Mailing address
PO BOX 1089, FAYETTE, MS 39069-1089
(601) 786-3888
(601) 786-9400
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
711
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00220117
—
MS
05
—
00770618
—
MS
Enumeration date
09/29/2005
Last updated
04/15/2008
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