Healthcare Provider Details

I. General information

NPI: 1508906223
Provider Name (Legal Business Name): NORTHEAST MISSISSIPPI COMMUNITY SERVICES, INC..
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 HATCHIE ST
BOONEVILLE MS
38829-4803
US

IV. Provider business mailing address

PO BOX 930
BOONEVILLE MS
38829-0930
US

V. Phone/Fax

Practice location:
  • Phone: 662-728-2118
  • Fax: 662-728-8720
Mailing address:
  • Phone: 662-728-2118
  • Fax: 662-728-8720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. SONIA PRESLEY
Title or Position: FISCAL OFFICER
Credential:
Phone: 662-728-2118