JEFFERSON DAVIS EXTENDED CARE FACILITY
NPI 1518245307
Skilled Nursing Facility in Prentiss, MS

Active since July 27, 2011CLIA 25D0910815 · Waiver
1102 ROSE ST, PRENTISS, MS 39474(601) 792-1172(601) 792-1267 Get Directions Write a Review

NPPES record last updated: December 20, 2011. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jefferson Davis Extended Care Facility NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JEFFERSON DAVIS EXTENDED CARE FACILITY (NPI 1518245307) is a healthcare organization registered as a skilled nursing facility in Prentiss, Mississippi and active in the NPI registry since July 2011. The organization holds a CLIA Waiver certificate valid through January 21, 2028 and lists Richard Andrew Woodard, Chief Financial Officer, as its authorized official.

NPPES Registry Identity

NPI1518245307
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameFORREST COUNTY GENERAL HOSPITAL
Location Address1102 ROSE STPrentiss, MS 39474-5200
Mailing AddressPo Box 1288Prentiss, MS 39474-1288 · (601) 792-1172 · Fax (601) 792-1267
Fax(601) 792-1267
Organization SubpartNo
Authorized OfficialRichard Andrew WoodardChief Financial Officer · (601) 288-2892
Enumeration DateJuly 27, 2011
Last NPPES UpdateDecember 20, 2011
NPI 1518245307 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License Licensed in MS · 254
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
1102 ROSE ST, Prentiss, MS 39474

Other Names 1

Doing Business AsJefferson Davis Extended Care Facility

Other Identifiers 1

Medicare OSCAR/certification255050MS

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 25D0910815

Jefferson Davis County Extended Care · Prentiss, MS
Active · expires Jan 21, 2028
CLIA Number25D0910815
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateJanuary 22, 2026
Certificate Expiration DateJanuary 21, 2028
Laboratory DirectorJoyce Fikes
Laboratory Phone(601) 792-4276
Laboratory LocationJefferson Davis County Extended Care1102 Rose Street, Prentiss, MS 39474
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Psychiatric Unit
1102 ROSE ST
PRENTISS, MS 39474
General Acute Care Hospital (Critical Access)
1102 ROSE ST
PRENTISS, MS 39474
Hospitalist
1102 ROSE ST
PRENTISS, MS 39474
General Acute Care Hospital (Critical Access)
1102 ROSE ST
PRENTISS, MS 39474
Occupational Therapist
1102 ROSE ST
PRENTISS, MS 39474
Emergency Medicine
1102 ROSE ST
PRENTISS, MS 39474
Speech-Language Pathologist
1102 ROSE ST
PRENTISS, MS 39474
Medicare Defined Swing Bed Unit
1102 ROSE ST
PRENTISS, MS 39474

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Forrest County General Hospital's NPI number?

The NPI number for Forrest County General Hospital is 1518245307. It was assigned to this organization in the NPPES registry on July 27, 2011. The provider is doing business as Jefferson Davis Extended Care Facility.

Where is Forrest County General Hospital located?

Forrest County General Hospital is located at 1102 Rose St, Prentiss, MS 39474. The listed phone number is (601) 792-1172.

What is Forrest County General Hospital's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Forrest County General Hospital hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D0910815) is associated with this NPI, valid through January 21, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Forrest County General Hospital was last updated on December 20, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.