Dynamic Natchez Operating Company LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

513 Issued in MS

Legal business name

DYNAMIC NATCHEZ OPERATING COMPANY LLC

Doing business as

Trace Haven Health & Rehab

Practice address

344 Arlington Avenue
Natchez, MS 39120-3551

Phone

(601) 442-4393

Fax

(601) 446-8909

NPI assigned

Feb 21, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Vicki M Hodge

Title

Business Office Manager

Phone

(601) 442-4393

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Trace Haven Health & Rehab Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144365784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "344 ARLINGTON AVENUE",
            "city": "NATCHEZ",
            "state": "MS",
            "postal_code": "391203551",
            "telephone_number": "601-442-4393",
            "fax_number": "601-446-8909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "344 ARLINGTON AVENUE",
            "city": "NATCHEZ",
            "state": "MS",
            "postal_code": "391203551",
            "telephone_number": "601-442-4393",
            "fax_number": "601-446-8909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC NATCHEZ OPERATING COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HODGE",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "601-442-4393",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "513",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00230073",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Trace Haven Health & Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lucinda Boswell Drane, APRN, FNP-BC
• Patrick A Duffy, MD
• Vikramaditya Dulam, M.D.
• Abram Henderson Dunbar, PT
• Jack Dunn, M.D.
• Davida Ealey, RDN, LD
• Ear, Nose & Throat of Natchez
• Edward Brown Specialty Partners of Mississippi, PLLC (Natchez Smiles)
• Edwards Chiropractic Center LLC
• Hal Sheldon Edwards, PHARM D.

• Skilled Nursing Facility in Natchez, MS
• Providers in Natchez, MS by specialty
• Skilled Nursing Facility in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.