Provider Demographics
NPI:1265429971
Name:TUNICA NURSING HOME
Entity type:Organization
Organization Name:TUNICA NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRAOTR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:LENARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-363-3164
Mailing Address - Street 1:1024 HIGHWAY 61 S
Mailing Address - Street 2:
Mailing Address - City:TUNICA
Mailing Address - State:MS
Mailing Address - Zip Code:38676-9440
Mailing Address - Country:US
Mailing Address - Phone:662-363-3164
Mailing Address - Fax:662-363-4191
Practice Address - Street 1:1024 HIGHWAY 61 S
Practice Address - Street 2:
Practice Address - City:TUNICA
Practice Address - State:MS
Practice Address - Zip Code:38676-9440
Practice Address - Country:US
Practice Address - Phone:662-363-3164
Practice Address - Fax:662-363-4191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS733313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS25A379Medicare ID - Type Unspecified05200732
MS25A379Medicare ID - Type Unspecified0500732