Organization
DESOTO HEALTHCARE INC
Active
Other names
DESOTO HEALTHCARE CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRENT TICE (VICE PRESIDENT)
(601) 928-5890
Entity
Organization
Contact information
Practice address
7805 SOUTHCREST PKWY, SOUTHAVEN, MS 38671-4741
(662) 349-7500
(662) 349-2069
Mailing address
748 HALL ST, WIGGINS, MS 39577-2108
(601) 928-5890
(601) 928-5807
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
771
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0230185
—
MS
Enumeration date
11/11/2005
Last updated
01/15/2010
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