Provider Demographics
NPI:1093811903
Name:CALHOUN HEALTH SERVICES NURSING HOME
Entity Type:Organization
Organization Name:CALHOUN HEALTH SERVICES NURSING HOME
Other - Org Name:CALHOUN COUNTY NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FISCAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-628-6611
Mailing Address - Street 1:152 BURKE CALHOUN CITY RD
Mailing Address - Street 2:
Mailing Address - City:CALHOUN CITY
Mailing Address - State:MS
Mailing Address - Zip Code:38916
Mailing Address - Country:US
Mailing Address - Phone:662-628-6611
Mailing Address - Fax:662-628-5707
Practice Address - Street 1:152 BURKE CALHOUN CITY RD
Practice Address - Street 2:
Practice Address - City:CALHOUN CITY
Practice Address - State:MS
Practice Address - Zip Code:38916
Practice Address - Country:US
Practice Address - Phone:662-628-6611
Practice Address - Fax:662-628-5707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1084313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00023023Medicaid