Covenant Health & Rehab of Vicksburg, LP

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

595 Issued in MS

Legal business name

COVENANT HEALTH & REHAB OF VICKSBURG, LP

Practice address

2850 Porters Chapel Rd
Vicksburg, MS 39180-1805

Phone

(601) 638-9211

Fax

(601) 636-4986

NPI assigned

May 11, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Judy Ullery

Title

President

Phone

(901) 937-7994

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186704000000",
    "number": "1548210289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2850 PORTERS CHAPEL RD",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391801805",
            "telephone_number": "601-638-9211",
            "fax_number": "601-636-4986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2850 PORTERS CHAPEL RD",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391801805",
            "telephone_number": "601-638-9211",
            "fax_number": "601-636-4986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT HEALTH & REHAB OF VICKSBURG, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2007-08-10",
        "status": "A",
        "authorized_official_last_name": "ULLERY",
        "authorized_official_first_name": "JUDY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "901-937-7994",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "595",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0220282",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gwendolyn Corrothers Royal, FNP-C
• Counseling Services LLC
• Bryona Courtney
• Cassie Courts
• Covenant Health & Rehab of Vicksburg, LLC
• Mindy Crabb
• Brandon J Craft, NP
• Rhys Kurt Crasto, MD
• Candi S Crawford
• James Hullon Crawford, RDMS

• Skilled Nursing Facility in Vicksburg, MS
• Providers in Vicksburg, 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 10, 2007; 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.