Provider Demographics
NPI:1427076256
Name:THE LANDMARK NURSING CENTER INC.
Entity type:Organization
Organization Name:THE LANDMARK NURSING CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:C.
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, NHA
Authorized Official - Phone:662-720-0972
Mailing Address - Street 1:100 LAUREN DR
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-2507
Mailing Address - Country:US
Mailing Address - Phone:662-720-0972
Mailing Address - Fax:662-720-0977
Practice Address - Street 1:100 LAUREN DR
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-2507
Practice Address - Country:US
Practice Address - Phone:662-720-0972
Practice Address - Fax:662-720-0977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS958314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00230166Medicaid