Healthcare Provider Details

I. General information

NPI: 1376533778
Provider Name (Legal Business Name): SOUTH MISSISSIPPI HOME HEALTH INC - REGION II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WHITEBROOK DR
BROOKHAVEN MS
39601-3367
US

IV. Provider business mailing address

PO BOX 51266
LAFAYETTE LA
70505-1266
US

V. Phone/Fax

Practice location:
  • Phone: 601-835-1145
  • Fax: 601-833-6273
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 Number10595
License Number StateMS

VIII. Authorized Official

Name: DONALD D. STELLY
Title or Position: VICE PRESIDENT
Credential:
Phone: 337-233-1307