Provider Demographics
NPI:1881831584
Name:CHARLESTON PLACE
Entity Type:Organization
Organization Name:CHARLESTON PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL CORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-862-2165
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843-0127
Mailing Address - Country:US
Mailing Address - Phone:662-862-2465
Mailing Address - Fax:662-862-9592
Practice Address - Street 1:804 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-6049
Practice Address - Country:US
Practice Address - Phone:662-862-2465
Practice Address - Fax:662-862-9525
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DANIEL HEALTH CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-16
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1017310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility