Provider Demographics
NPI:1336895762
Name:POND, ELIZABETH ANN (EXECUTIVE DIRECTOR)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:POND
Suffix:
Gender:F
Credentials:EXECUTIVE DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 BAY COVE DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-5546
Mailing Address - Country:US
Mailing Address - Phone:228-702-9972
Mailing Address - Fax:228-702-9978
Practice Address - Street 1:670 BAY COVE DR
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-5546
Practice Address - Country:US
Practice Address - Phone:228-702-9972
Practice Address - Fax:228-702-9978
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1066376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator