Organization
BEDFORD CARE CENTER OF PETAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN A. WORREL (CONTROLLER)
(601) 583-3232
Entity
Organization
Contact information
Practice address
908 SOUTH GEORGE STREET, PETAL, MS 39465-2014
(601) 544-7441
(601) 582-3217
Mailing address
100 W PINE ST, HATTIESBURG, MS 39401-3467
(601) 583-3232
(601) 582-7539
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
140
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000080355
BCBS PROVIDER NUMBER
MS
05
—
00230155
—
MS
Enumeration date
11/15/2005
Last updated
01/15/2010
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