Organization
DUNBAR VILLAGE L.P.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CAMERON DIRK GODDARD (AR MANAGER)
(601) 824-9010
Entity
Organization
Contact information
Practice address
725 DUNBAR AVE, BAY ST LOUIS, MS 39520-2920
(228) 466-3099
(228) 466-3994
Mailing address
106A OFFICE PARK DR, BRANDON, MS 39042-2404
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
855
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0230081
—
MS
Enumeration date
04/10/2007
Last updated
12/05/2007
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