Organization
DESOTO PEDIATRIC EXTENDED CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAUREEN GALLAGHER (OWNER)
(318) 512-9218
Entity
Organization
Contact information
Practice address
750 STATELINE ROAD EAST, SOUTHHAVEN, MS 38671
(662) 468-1320
Mailing address
PO BOX 2994, MONROE, LA 71207-2994
Taxonomy
Speciality
Code
Description
License number
State
3140N1450X
Pediatric Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
01/27/2016
Last updated
01/27/2016
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