Organization
BELHAVEN SENIOR CARE
Active
Other names
The Madison Health and Rehab
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW CORLEY WAGNER LNHA (ADMINISTRATOR)
(601) 898-6080
Entity
Organization
Contact information
Practice address
111 KELLY BLVD, MADISON, MS 39110
(601) 898-6080
(601) 898-6348
Mailing address
111 KELLY BLVD, MADISON, MS 39110
(601) 898-6080
(601) 898-6348
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
624
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00230161
—
MS
Enumeration date
08/10/2007
Last updated
10/04/2024
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