Provider Demographics
NPI:1770558215
Name:BRIAR HILL REST HOME, LLC
Entity type:Organization
Organization Name:BRIAR HILL REST HOME, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DRANGUET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-853-2667
Mailing Address - Street 1:14 PROFESSIONAL PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157
Mailing Address - Country:US
Mailing Address - Phone:601-853-2667
Mailing Address - Fax:
Practice Address - Street 1:1201 GUNTER RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MS
Practice Address - Zip Code:39073-9711
Practice Address - Country:US
Practice Address - Phone:601-939-6371
Practice Address - Fax:601-939-6228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS157314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08102260Medicaid
MS08102260Medicaid