Hattiesburg Convalescent Home, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

25 Issued in MS

Legal business name

HATTIESBURG CONVALESCENT HOME, INC.

Practice address

514 Bay St
Hattiesburg, MS 39401-3933

Phone

(601) 544-4230

Fax

(601) 582-2480

NPI assigned

Oct 13, 2005

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. Jewell C McMahan

Title

Administrator

Phone

(601) 544-4230

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Hattiesburg Convalescent Center Other name

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

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1922096866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 BAY ST",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394013933",
            "telephone_number": "601-544-4230",
            "fax_number": "601-582-2480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 BAY ST",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394013933",
            "telephone_number": "601-544-4230",
            "fax_number": "601-582-2480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HATTIESBURG CONVALESCENT HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCMAHAN",
        "authorized_official_first_name": "JEWELL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-544-4230",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "25",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0023061",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hattiesburg Convalescent Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• 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.