Organization
MADISON COUNTY NURSING HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL LOGAN (ADMINISTRATOR)
(601) 855-5771
Entity
Organization
Contact information
Practice address
1421A E PEACE ST, CANTON, MS 39046-4938
(601) 855-5760
Mailing address
1421A E PEACE ST, P.O. BOX 488, CANTON, MS 39046-4938
(601) 855-5760
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
187
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00023095
—
MS
Enumeration date
01/12/2007
Last updated
03/23/2010
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