Provider Demographics
NPI:1922056050
Name:SHARKEY-ISSAQUENA COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:SHARKEY-ISSAQUENA COMMUNITY HOSPITAL
Other - Org Name:SHARKEY-ISSAQUENA NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:KEEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-873-4395
Mailing Address - Street 1:431 WEST RACE STREET
Mailing Address - Street 2:
Mailing Address - City:ROLLING FORK
Mailing Address - State:MS
Mailing Address - Zip Code:39159
Mailing Address - Country:US
Mailing Address - Phone:662-873-6218
Mailing Address - Fax:662-873-6050
Practice Address - Street 1:431 WEST RACE STREET
Practice Address - Street 2:
Practice Address - City:ROLLING FORK
Practice Address - State:MS
Practice Address - Zip Code:39159
Practice Address - Country:US
Practice Address - Phone:662-873-6218
Practice Address - Fax:662-873-6050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS539314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00230129Medicaid
MS80489OtherBLUE CROSS BLUE SHIELD
MS255220Medicare Oscar/Certification