Provider Demographics
NPI:1245394501
Name:WASHINGTON COUNTY LTC, INC.
Entity Type:Organization
Organization Name:WASHINGTON COUNTY LTC, INC.
Other - Org Name:MS CARE CENTER OF GREENVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-335-5811
Mailing Address - Street 1:1221 E UNION ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-3243
Mailing Address - Country:US
Mailing Address - Phone:662-335-5811
Mailing Address - Fax:662-332-2551
Practice Address - Street 1:1221 E UNION ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-3243
Practice Address - Country:US
Practice Address - Phone:662-335-5811
Practice Address - Fax:662-332-2551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS738314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00230075Medicaid
MS255252Medicare ID - Type Unspecified