Healthcare Provider Details

I. General information

NPI: 1023257276
Provider Name (Legal Business Name): MISSISSIPPI HOMECARE OF MERIDIAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 10/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12731 HIGHWAY 17 SUITE 5
GILBERTOWN AL
36908-5229
US

IV. Provider business mailing address

PO BOX 51266
LAFAYETTE LA
70505-1266
US

V. Phone/Fax

Practice location:
  • Phone: 251-843-2808
  • Fax:
Mailing address:
  • Phone: 337-233-1307
  • Fax: 337-233-5764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER C. NOVEMBER II
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 337-233-1307