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Contact Information

SHADY LAWN, LLC
60 SHADY LAWN PL
VICKSBURG, MS39180
 Phone: 601-636-1448
 Fax: 601-636-8811
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Skilled Nursing Facility

314000000X A1[8] Skilled Nursing Facility
Indicates primary specialty

NPI Profile & details for SHADY LAWN, LLC

NPI Number 1184613143
LBN Legal business name SHADY LAWN, LLC
Authorized official WILLIAM ORAND - (CEO)
Entity Organization
Organization subpart 1 Yes
Enumeration date 10/20/2005
Last updated 05/24/2018 - About 8 years ago
Identifiers
MS License # 182
MS Medicaid 00220335
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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