Provider Demographics
NPI:1609865450
Name:DUGAN MEMORIAL HOME, INC.
Entity Type:Organization
Organization Name:DUGAN MEMORIAL HOME, INC.
Other - Org Name:DUGAN MEMORIAL HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCALILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-844-8977
Mailing Address - Street 1:804 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-3137
Mailing Address - Country:US
Mailing Address - Phone:662-494-3640
Mailing Address - Fax:662-494-3641
Practice Address - Street 1:804 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-3137
Practice Address - Country:US
Practice Address - Phone:662-494-3640
Practice Address - Fax:662-494-3641
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSISSIPPI METHODIST SENIOR SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-14
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00230173Medicaid
MS255313Medicare ID - Type Unspecified