Healthcare Provider Details

I. General information

NPI: 1023008455
Provider Name (Legal Business Name): SOUTH MISSISSIPPI HOME HEALTH, INC. REGION III DBA DEACONESS HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 W MINNESOTA PARK RD
HAMMOND LA
70403-6148
US

IV. Provider business mailing address

PO BOX 16929
HATTIESBURG MS
39404-6929
US

V. Phone/Fax

Practice location:
  • Phone: 985-429-1380
  • Fax: 985-429-1344
Mailing address:
  • Phone: 601-268-1842
  • Fax: 601-268-7898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1007
License Number StateLA

VIII. Authorized Official

Name: MS. NANCY C JAKUS
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential: RN, BSN, MBA
Phone: 601-268-1842