Provider Demographics
NPI:1912774183
Name:MANTACHIE RURAL HEALTH CARE, INC
Entity Type:Organization
Organization Name:MANTACHIE RURAL HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:CRABB
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-282-4226
Mailing Address - Street 1:5681 HIGHWAY 363
Mailing Address - Street 2:
Mailing Address - City:MANTACHIE
Mailing Address - State:MS
Mailing Address - Zip Code:38855-7632
Mailing Address - Country:US
Mailing Address - Phone:166-225-5156
Mailing Address - Fax:
Practice Address - Street 1:5681 HIGHWAY 363
Practice Address - Street 2:
Practice Address - City:MANTACHIE
Practice Address - State:MS
Practice Address - Zip Code:38855-7632
Practice Address - Country:US
Practice Address - Phone:662-282-4226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)