Organization
NORTH STREET HEALTHCARE LLC
Active
Other names
Comperes Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES BRUCE KELLY (MANAGING MEMBER)
(601) 304-0980
Entity
Organization
Contact information
Practice address
865 NORTH ST, JACKSON, MS 39202-3020
(601) 948-6531
(601) 948-6166
Mailing address
323 HIGHLAND BLVD, NATCHEZ, MS 39120-4635
(601) 304-0980
(601) 304-1155
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
APPLING FOR
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00230016
—
MS
Enumeration date
12/16/2009
Last updated
12/16/2009
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