Organization
2ND GENERATION HEALTHCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL ALLAN BRADSHAW (MEMBER)
(601) 736-4747
Entity
Organization
Contact information
Practice address
11 PECAN DR, COLUMBIA, MS 39429
(601) 736-4747
Mailing address
11 PECAN DR, COLUMBIA, MS 39429-2600
(601) 736-4747
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
461
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00023026
—
MS
Enumeration date
08/01/2011
Last updated
06/01/2018
About Stedi
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