Organization
TISHOMINGO COMMUNITY CARE CENTER LLC
Active
Other names
Tishomingo Manor
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TONI PARKINSON (AUTHORIZED REPRESENTATIVE)
(601) 709-1408
Entity
Organization
Contact information
Practice address
230 KAKI AVE, IUKA, MS 38852-1192
(662) 423-9112
(662) 423-9121
Mailing address
230 KAKI AVE, IUKA, MS 38852-1192
(662) 423-9112
(662) 423-9121
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
414
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00230109
—
MS
01
—
80488
BLUE CROSS BLUE SHIELD
MS
Enumeration date
05/05/2006
Last updated
04/30/2013
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