Organization
HERITAGE MANOR PCH, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CARROL ANN HUDSPETH (PRESIDENT)
(601) 757-0059
Entity
Organization
Contact information
Practice address
2051 FERGUSON MILL RD, SILVER CREEK, MS 39663-4435
(601) 886-7251
(601) 886-9990
Mailing address
PO BOX 1337, MONTICELLO, MS 39654-1337
(601) 886-7251
(601) 886-9990
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
875
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06376862
—
MS
Enumeration date
04/07/2008
Last updated
04/07/2008
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