Healthcare Provider Details

I. General information

NPI: 1255275251
Provider Name (Legal Business Name): FOSTER LEGACY CARE SERVICES MS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2026
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 CEMETERY RD
EDWARDS MS
39066-9705
US

IV. Provider business mailing address

716 CEMETERY RD
EDWARDS MS
39066-9705
US

V. Phone/Fax

Practice location:
  • Phone: 601-339-1509
  • Fax:
Mailing address:
  • Phone: 601-339-1509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: ERICA FOSTER
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 601-339-1509