NPI 1053386870

Grenada Lake Medical Center

Organisation Skilled Nursing Facility Grenada, MS

Practice location

Address: 960 Avent Dr, Grenada, MS 38901-5230
Phone: (662) 227-7000
Fax: (662) 227-7534

Authorised official

Name: Charles L Denton
Title: Ceo
Phone: (662) 227-7005

Registered specialties

Skilled Nursing Facility Primary

Nursing & Custodial Care Facilities Taxonomy 314000000X Licence 11245 (MS)

Other Skilled Nursing Facility providers in Mississippi →

Registry record

NPI: 1053386870
Entity type: Organization
NPI issued: 23 Feb 2006
Record last updated: 12 Dec 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.