Organization
PEDIATRUST HATTIESBURG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEANN CRAIG (OWNER)
(225) 252-7633
Entity
Organization
Contact information
Practice address
6270 SEVENOAKS AVE, BATON ROUGE, LA 70806-7330
(225) 252-7633
Mailing address
6270 SEVENOAKS AVE, BATON ROUGE, LA 70806-7330
(225) 252-7633
Taxonomy
Speciality
Code
Description
License number
State
3140N1450X
Pediatric Skilled Nursing Facility
Primary
1902256191
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
475088111
—
MS
Enumeration date
06/17/2016
Last updated
01/03/2017
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