Wilkinson County Nursing Center LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

379 Issued in MS

Legal business name

WILKINSON COUNTY NURSING CENTER LLC

Practice address

166 S Lafayette St
Centreville, MS 39631-0310

Phone

(601) 645-5253

Fax

(601) 645-6389

NPI assigned

Dec 6, 2005

Last updated

Aug 10, 2007By 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. Tina L Ellis

Title

Comptroller

Phone

(601) 304-0980

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1133827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186704000000",
    "number": "1548244262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 310",
            "address_2": "166 S LAFAYETTE ST",
            "city": "CENTREVILLE",
            "state": "MS",
            "postal_code": "396310310",
            "telephone_number": "601-645-5253",
            "fax_number": "601-645-6389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 S LAFAYETTE ST",
            "city": "CENTREVILLE",
            "state": "MS",
            "postal_code": "396310310",
            "telephone_number": "601-645-5253",
            "fax_number": "601-645-6389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILKINSON COUNTY NURSING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-06",
        "last_updated": "2007-08-10",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "COMPTROLLER",
        "authorized_official_telephone_number": "601-304-0980",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "379",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00230138",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles Gerald Rymer, R.PH.
• Jacqueline Benoit Schott, LCSW
• SE Mississippi Emergency Physicians LLC
• Thomas Lobrano DDS PA
• Shelby T White, MD
• Wilkinson County Senior Care LLC

• Skilled Nursing Facility in Centreville, MS
• Providers in Centreville, 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.