Provider Demographics
NPI:1194815365
Name:STONE COUNTY REHABILITATION AND NURSING CENTER INC
Entity Type:Organization
Organization Name:STONE COUNTY REHABILITATION AND NURSING CENTER INC
Other - Org Name:MEMORIAL STONE COUNTY NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:T
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-832-4220
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:WIGGINS
Mailing Address - State:MS
Mailing Address - Zip Code:39577-0246
Mailing Address - Country:US
Mailing Address - Phone:601-928-1889
Mailing Address - Fax:601-928-2335
Practice Address - Street 1:1436 CENTRAL AVE E
Practice Address - Street 2:
Practice Address - City:WIGGINS
Practice Address - State:MS
Practice Address - Zip Code:39577-9602
Practice Address - Country:US
Practice Address - Phone:601-928-1889
Practice Address - Fax:601-928-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01973898Medicaid
MS255308Medicare ID - Type Unspecified