Provider Demographics
NPI:1649595349
Name:CHOCTAW COUNTY NURSING CENTER
Entity Type:Organization
Organization Name:CHOCTAW COUNTY NURSING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-285-6329
Mailing Address - Street 1:PO BOX 360
Mailing Address - Street 2:
Mailing Address - City:ACKERMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39735-0360
Mailing Address - Country:US
Mailing Address - Phone:662-285-3257
Mailing Address - Fax:662-285-2725
Practice Address - Street 1:311 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:ACKERMAN
Practice Address - State:MS
Practice Address - Zip Code:39735-8708
Practice Address - Country:US
Practice Address - Phone:662-285-3257
Practice Address - Fax:662-285-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS242313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility