Organization
LEAKE EXTENDED CARE FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANDY GOOLSBY (ACCOUNTANT BUSINESS OFFICE MANAGER)
(601) 267-1100
Entity
Organization
Contact information
Practice address
310 ELLIS ST, CARTHAGE, MS 39051-3809
(601) 267-1100
(601) 267-1211
Mailing address
310 ELLIS ST, CARTHAGE, MS 39051-3809
(601) 267-1100
(601) 267-1211
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
214
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00230186
—
MS
Enumeration date
11/21/2006
Last updated
08/22/2020
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