Provider Demographics
NPI:1568683498
Name:WHITFIELD NURSING HOME, INC.
Entity Type:Organization
Organization Name:WHITFIELD NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-286-3331
Mailing Address - Street 1:2101 PROPER ST
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-5247
Mailing Address - Country:US
Mailing Address - Phone:662-286-3331
Mailing Address - Fax:662-286-0026
Practice Address - Street 1:2101 PROPER ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-5247
Practice Address - Country:US
Practice Address - Phone:662-286-3331
Practice Address - Fax:662-286-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS168313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00023154Medicaid
MS25E015OtherFEDERAL IDENTIFIER