Provider Demographics
NPI:1215170832
Name:BEDFORD CARE CENTER OF MARION, LLC
Entity type:Organization
Organization Name:BEDFORD CARE CENTER OF MARION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCELROY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:601-583-3232
Mailing Address - Street 1:100 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-3467
Mailing Address - Country:US
Mailing Address - Phone:601-583-3232
Mailing Address - Fax:601-582-7539
Practice Address - Street 1:6434A DALE DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:MS
Practice Address - Zip Code:39342-8704
Practice Address - Country:US
Practice Address - Phone:601-294-3515
Practice Address - Fax:601-693-3198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS524314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09471018Medicaid
MS09471018Medicaid