Organization
HATTIESBURG CONVALESCENT HOME, INC.
Active
Other names
Hattiesburg Convalescent Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JEWELL C MCMAHAN (ADMINISTRATOR)
(601) 544-4230
Entity
Organization
Contact information
Practice address
514 BAY ST, HATTIESBURG, MS 39401-3933
(601) 544-4230
(601) 582-2480
Mailing address
514 BAY ST, HATTIESBURG, MS 39401-3933
(601) 544-4230
(601) 582-2480
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0017704.1
MS
314000000X
Skilled Nursing Facility
25
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00036421
—
MS
05
—
0023061
—
MS
Enumeration date
02/13/2007
Last updated
09/11/2025
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