Organization
GRENADA LAKE MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES L DENTON (CEO)
(662) 227-7000
Entity
Organization
Contact information
Practice address
960 AVENT DR, GRENADA, MS 38901-5230
(662) 227-7000
(662) 227-7534
Mailing address
960 AVENT DR, GRENADA, MS 38901-5230
(662) 227-7000
(662) 227-7534
Taxonomy
Speciality
Code
Description
License number
State
282NR1301X
Rural Acute Care Hospital
Primary
11245
MS
Other
Enumeration date
07/28/2005
Last updated
06/15/2012
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