Organization
SENTRY-GAUTIER, INC.
Active
Other names
RIVER CHASE VILLAGE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CAMERON DIRK GODDARD (AR MANAGER)
(601) 824-9010
Entity
Organization
Contact information
Practice address
5090 GAUTIER VANCLEAVE ROAD, GAUTIER, MS 39553
(228) 522-6700
(228) 522-3383
Mailing address
106A OFFICE PARK DRIVE, BRANDON, MS 39042
(601) 824-9010
(601) 824-9044
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
956
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00230163
—
MS
Enumeration date
09/15/2006
Last updated
02/16/2012
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