Provider Demographics
NPI:1215970397
Name:STARKVILLE MANOR HEALTHCARE LLC
Entity type:Organization
Organization Name:STARKVILLE MANOR HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:LEHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-698-9040
Mailing Address - Street 1:PO BOX 1466
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39760-1466
Mailing Address - Country:US
Mailing Address - Phone:662-323-6360
Mailing Address - Fax:662-323-4413
Practice Address - Street 1:1001 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39760-1466
Practice Address - Country:US
Practice Address - Phone:662-323-6360
Practice Address - Fax:662-323-4413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS555314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000220164Medicaid
MS00220164Medicaid