Healthcare Provider Details

I. General information

NPI: 1841372976
Provider Name (Legal Business Name): SOUTHWEST DEVELOPMENT CORPORATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 GILCHRIST STREET
FAYETTE MS
39069-0699
US

IV. Provider business mailing address

PO BOX 699
FAYETTE MS
39069-0699
US

V. Phone/Fax

Practice location:
  • Phone: 601-786-3955
  • Fax: 601-786-9814
Mailing address:
  • Phone: 601-786-3955
  • Fax: 601-786-9814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7181
License Number StateMS

VIII. Authorized Official

Name: MS. MARY T. IRVING
Title or Position: ADMINISTRATOR
Credential:
Phone: 601-786-3955