Organization
COLUMBIA COMMUNITY CARE CENTER LLC
Active
Other names
The Myrtles Nursing Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TONI PARKINSON (AUTHORIZED REPRESENTATIVE)
(601) 709-1408
Entity
Organization
Contact information
Practice address
1018 ALBERTA AVE, COLUMBIA, MS 39429-2552
(601) 731-1745
(601) 736-3886
Mailing address
1018 ALBERTA AVE, COLUMBIA, MS 39429-2552
(601) 731-1745
(601) 736-3886
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
464
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000080387
BLUE CROSS BLUE SHIELD MS
MS
05
—
00230115
—
MS
Enumeration date
05/04/2006
Last updated
02/22/2017
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