NPIMap

Organization Active NPI

Dynamic Indianola Operating LLC

  • Skilled Nursing Facility
  • Indianola, MS
National Provider Identifier
1295882918
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
505 Issued in MS
Legal business name
DYNAMIC INDIANOLA OPERATING LLC
Practice address
401 Highway 82 W
Indianola, MS 38751-2030
Phone
(662) 887-2682
Fax
(662) 887-3817
NPI assigned
Jan 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Rebecca Rylee
Title
Administrator
Phone
(662) 887-2682

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 505 MS Primary

Addresses

Primary practice location

401 Highway 82 W
Indianola, MS 38751-2030

Mailing address

401 Highway 82 W
Indianola, MS 38751-2030
Phone (662) 887-2682

Other identifiers 1

IdentifierTypeStateIssuer
00230072MedicaidMS

Other names 1

  • Indianola Health & Rehabilitation Center Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295882918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 HIGHWAY 82 W",
            "city": "INDIANOLA",
            "state": "MS",
            "postal_code": "387512030",
            "telephone_number": "662-887-2682",
            "fax_number": "662-887-3817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 HIGHWAY 82 W",
            "city": "INDIANOLA",
            "state": "MS",
            "postal_code": "387512030",
            "telephone_number": "662-887-2682",
            "fax_number": "662-887-3817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC INDIANOLA OPERATING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RYLEE",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "662-887-2682",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00230072",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indianola Health & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianola, MS

Sources for this page

  • 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.