Organization
WISTERIA GARDENS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM D HILL JR. (ADMINISTRATOR)
(601) 988-6800
Entity
Organization
Contact information
Practice address
5420 HIGHWAY 80 E, PEARL, MS 39208-8924
(601) 988-6800
Mailing address
5420 HIGHWAY 80 E, PEARL, MS 39208-8924
(601) 988-6800
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
09/12/2007
Last updated
09/12/2007
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