Provider Demographics
NPI:1144365784
Name:DYNAMIC NATCHEZ OPERATING COMPANY LLC
Entity type:Organization
Organization Name:DYNAMIC NATCHEZ OPERATING COMPANY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:M
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-442-4393
Mailing Address - Street 1:344 ARLINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-3551
Mailing Address - Country:US
Mailing Address - Phone:601-442-4393
Mailing Address - Fax:601-446-8909
Practice Address - Street 1:344 ARLINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-3551
Practice Address - Country:US
Practice Address - Phone:601-442-4393
Practice Address - Fax:601-446-8909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS513314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00230073Medicaid
MS255226Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER