Organization
PIKE COMMUNITY CARE CENTER LLC
Active
Other names
Camellia Estates
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TONI PARKINSON (AUTHORIZED REPRESENTATIVE)
(601) 709-1408
Entity
Organization
Contact information
Practice address
1714 WHITE ST, MCCOMB, MS 39648-2712
(601) 250-0066
(601) 250-0640
Mailing address
1714 WHITE ST, MCCOMB, MS 39648-2712
(601) 250-0066
(601) 250-0640
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
908
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000080491
BLUE CROSS BLUE SHIELD MS
MS
Enumeration date
05/04/2006
Last updated
05/03/2019
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