Organization
HATTIESBURG CONVALESCENT HOME, INC.
Active
Other names
Hattiesburg Convalescent Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JEWELL C MCMAHAN (ADMINISTRATOR)
(601) 544-4230
Entity
Organization
Contact information
Practice address
514 BAY ST, HATTIESBURG, MS 39401-3933
(601) 544-4230
(601) 582-2480
Mailing address
514 BAY ST, HATTIESBURG, MS 39401-3933
(601) 544-4230
(601) 582-2480
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
25
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0023061
—
MS
Enumeration date
10/13/2005
Last updated
08/22/2020
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