Provider Demographics
NPI:1356772594
Name:JEFFERSON COUNTY NURSING HOME THERAPY
Entity type:Organization
Organization Name:JEFFERSON COUNTY NURSING HOME THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONTINA
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:FLETCHER-LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:601-786-3888
Mailing Address - Street 1:P.O. BOX 1089
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MS
Mailing Address - Zip Code:39069
Mailing Address - Country:US
Mailing Address - Phone:601-786-3888
Mailing Address - Fax:601-786-9400
Practice Address - Street 1:910 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MS
Practice Address - Zip Code:39069
Practice Address - Country:US
Practice Address - Phone:601-786-3888
Practice Address - Fax:601-786-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital