Provider Demographics
NPI:1417332040
Name:BEDFORD CARE CENTER-WARREN HALL, LLC
Entity Type:Organization
Organization Name:BEDFORD CARE CENTER-WARREN HALL, LLC
Other - Org Name:BEDFORD CARE CENTER OF PICAYUNE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WORREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-583-3232
Mailing Address - Street 1:100 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-3467
Mailing Address - Country:US
Mailing Address - Phone:601-583-3232
Mailing Address - Fax:601-582-7539
Practice Address - Street 1:2797 COOPER RD
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466
Practice Address - Country:US
Practice Address - Phone:601-799-1616
Practice Address - Fax:601-799-0725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility