Provider Demographics
NPI:1285179887
Name:PLATINUM PLUS CARE
Entity Type:Organization
Organization Name:PLATINUM PLUS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:MAPLE
Authorized Official - Middle Name:LEAN
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-445-2600
Mailing Address - Street 1:PO BOX 649
Mailing Address - Street 2:617 HIGWAY 82 WEST
Mailing Address - City:INDIANOLA
Mailing Address - State:MS
Mailing Address - Zip Code:38751-0649
Mailing Address - Country:US
Mailing Address - Phone:662-445-2600
Mailing Address - Fax:
Practice Address - Street 1:617 HIGHWAY 82 W
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:MS
Practice Address - Zip Code:38751-2056
Practice Address - Country:US
Practice Address - Phone:662-445-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS205593310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility