Organization
AZALEA GARDENS NURSING CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AVONNA CATHERINE CAIN (OWNER)
(601) 928-5281
Entity
Organization
Contact information
Practice address
530 HALL ST, WIGGINS, MS 39577-2631
(601) 928-5281
(601) 928-9090
Mailing address
530 HALL STREET, WIGGINS, MS 39577
(601) 928-5281
(601) 928-9090
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
195
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00023012
—
MS
05
—
23012
—
MS
Enumeration date
10/12/2006
Last updated
02/18/2010
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