Organization
TUNICA NURSING HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MONICA LENARD (BUSINESS OFFICE MANAGER)
(662) 363-3164
Entity
Organization
Contact information
Practice address
1024 HIGHWAY 61 S, TUNICA, MS 38676-9440
(662) 363-3164
(662) 363-4191
Mailing address
1024 HIGHWAY 61 S, TUNICA, MS 38676-9440
(662) 363-3164
(662) 363-4191
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
733
MS
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05200732
—
MS
01
—
25A379
MEDICARE
MS
Enumeration date
12/19/2007
Last updated
04/24/2008
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