Provider Demographics
NPI:1790849644
Name:SCOTT COUNTY LTC, INC.
Entity Type:Organization
Organization Name:SCOTT COUNTY LTC, INC.
Other - Org Name:MS CARE CENTER OF MORTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCURDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-732-6361
Mailing Address - Street 1:96 OLD HIGHWAY 80 E
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:MS
Mailing Address - Zip Code:39117-9771
Mailing Address - Country:US
Mailing Address - Phone:601-732-6361
Mailing Address - Fax:601-732-2220
Practice Address - Street 1:96 OLD HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:MS
Practice Address - Zip Code:39117-9771
Practice Address - Country:US
Practice Address - Phone:601-732-6361
Practice Address - Fax:601-732-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1193314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00230079Medicaid
MS255250OtherMEDICARE PTAN