Provider Demographics
NPI:1063673820
Name:MS HUD DIXIE LLC
Entity Type:Organization
Organization Name:MS HUD DIXIE LLC
Other - Org Name:PASS CHRISTIAN HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-430-0000
Mailing Address - Street 1:40 PALAFOX PL
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-5697
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:538 MENGE AVE
Practice Address - Street 2:
Practice Address - City:PASS CHRISTIAN
Practice Address - State:MS
Practice Address - Zip Code:39571-4234
Practice Address - Country:US
Practice Address - Phone:228-452-4344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUD FACILITIES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-24
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS255287Medicare Oscar/Certification