Provider Demographics
NPI:1841755865
Name:NISSI LLC
Entity Type:Organization
Organization Name:NISSI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:601-469-4389
Mailing Address - Street 1:410 E FIRST ST
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074-4204
Mailing Address - Country:US
Mailing Address - Phone:601-469-4389
Mailing Address - Fax:601-469-4377
Practice Address - Street 1:410 E FIRST ST
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074-4204
Practice Address - Country:US
Practice Address - Phone:601-469-4389
Practice Address - Fax:601-469-4377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness