Organization
WILKINSON COUNTY NURSING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TINA L ELLIS (COMPTROLLER)
(601) 304-0980
Entity
Organization
Contact information
Practice address
166 S LAFAYETTE ST, CENTREVILLE, MS 39631-0310
(601) 645-5253
(601) 645-6389
Mailing address
PO BOX 310, 166 S LAFAYETTE ST, CENTREVILLE, MS 39631-0310
(601) 645-5253
(601) 645-6389
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
379
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00230138
—
MS
Enumeration date
12/06/2005
Last updated
08/10/2007
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