Provider Demographics
NPI:1144983685
Name:MISSISSIPPI LTAC HOLDINGS, LLC
Entity type:Organization
Organization Name:MISSISSIPPI LTAC HOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-269-9566
Mailing Address - Street 1:101 LA RUE FRANCE STE 100
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3138
Mailing Address - Country:US
Mailing Address - Phone:337-269-9566
Mailing Address - Fax:337-269-9823
Practice Address - Street 1:303 MEDICAL CENTER DR STE B
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-8608
Practice Address - Country:US
Practice Address - Phone:662-703-4167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital