Organization
COTTAGE GROVE NURSING HOME, LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JUADINE B CLEVELAND (ADMINISTRATOR)
(601) 366-6461
Entity
Organization
Contact information
Practice address
1116 FOREST AVE, JACKSON, MS 39206-3216
(601) 366-6461
(601) 362-4041
Mailing address
1116 FOREST AVE, JACKSON, MS 39206-3216
(601) 366-6461
(601) 362-4041
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
326
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00023040
—
MS
Enumeration date
01/09/2007
Last updated
03/26/2013
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