Provider Demographics
NPI:1376727818
Name:TUNICA NURSING HOME LLC
Entity Type:Organization
Organization Name:TUNICA NURSING HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LENARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-363-3164
Mailing Address - Street 1:1024 HIGHWAY 61 S
Mailing Address - Street 2:
Mailing Address - City:TUNICA
Mailing Address - State:MS
Mailing Address - Zip Code:38676-9440
Mailing Address - Country:US
Mailing Address - Phone:662-363-3164
Mailing Address - Fax:662-363-4191
Practice Address - Street 1:1024 HIGHWAY 61 S
Practice Address - Street 2:
Practice Address - City:TUNICA
Practice Address - State:MS
Practice Address - Zip Code:38676-9440
Practice Address - Country:US
Practice Address - Phone:662-363-3164
Practice Address - Fax:662-363-4191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS733313M00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS25A379OtherMEDICARE
MS05200732Medicaid
MS5186930001Medicare NSC