Organization
PHC-CLEVELAND INC.
Active
Other names
Bolivar Medical Center Long Term Care Facility
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY TEAGUE (VICE PRESIDENT, CORPORATE SECRETARY)
(629) 253-5121
Entity
Organization
Contact information
Practice address
901 E SUNFLOWER RD, CLEVELAND, MS 38732-2833
(662) 846-0061
(662) 846-2380
Mailing address
330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-4536
(615) 920-7000
(615) 920-8913
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
151
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000080746
BLUE CROSS/SNF
MS
05
—
0230097
—
MS
Enumeration date
05/31/2006
Last updated
03/11/2024
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