Provider Demographics
NPI:1952307316
Name:DANIEL HEALTH CARE, INC.
Entity Type:Organization
Organization Name:DANIEL HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOLLAND
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:662-862-2165
Mailing Address - Fax:662-862-2167
Practice Address - Street 1:1905 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-8738
Practice Address - Country:US
Practice Address - Phone:662-862-2165
Practice Address - Fax:662-862-2167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS202314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00230144Medicaid
MS000080404OtherBLUE CROSS BLUE SHIELD MS
MS00230144Medicaid