Provider Demographics
NPI:1609259936
Name:MERIDIAN PEDIATRIC EXTENDED CARE LLC
Entity Type:Organization
Organization Name:MERIDIAN PEDIATRIC EXTENDED CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-912-0373
Mailing Address - Street 1:3850 HIGHWAY 45 N
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-1517
Mailing Address - Country:US
Mailing Address - Phone:601-912-0373
Mailing Address - Fax:601-910-7521
Practice Address - Street 1:3850 HIGHWAY 45 N
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-1517
Practice Address - Country:US
Practice Address - Phone:601-912-0373
Practice Address - Fax:601-910-7521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric