Provider Demographics
NPI:1073948790
Name:YALOBUSHA GENERAL HOSPITAL
Entity Type:Organization
Organization Name:YALOBUSHA GENERAL HOSPITAL
Other - Org Name:YALOBUSHA ADULT DAY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REVENUE
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-473-5143
Mailing Address - Street 1:218 FROSTLAND DR
Mailing Address - Street 2:
Mailing Address - City:WATER VALLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38965-2822
Mailing Address - Country:US
Mailing Address - Phone:662-473-1411
Mailing Address - Fax:662-473-4991
Practice Address - Street 1:218 FROSTLAND DR
Practice Address - Street 2:
Practice Address - City:WATER VALLEY
Practice Address - State:MS
Practice Address - Zip Code:38965-2822
Practice Address - Country:US
Practice Address - Phone:662-473-1411
Practice Address - Fax:662-473-4991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care