Provider Demographics
NPI:1043543929
Name:LEAKESVILLE REHABILITATION AND NURSING CENTER, INC.
Entity type:Organization
Organization Name:LEAKESVILLE REHABILITATION AND NURSING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:STARANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-832-4220
Mailing Address - Street 1:PO DRAWER 3269
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39505-3269
Mailing Address - Country:US
Mailing Address - Phone:228-832-4220
Mailing Address - Fax:228-832-4229
Practice Address - Street 1:1300 MELODY LN
Practice Address - Street 2:
Practice Address - City:LEAKESVILLE
Practice Address - State:MS
Practice Address - Zip Code:39451-6530
Practice Address - Country:US
Practice Address - Phone:601-394-2331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility