Healthcare Provider Details

I. General information

NPI: 1316318264
Provider Name (Legal Business Name): DEPENDABLE SOURCE CORP. OF MS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2015
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 S WEST ST SUITE A
JACKSON MS
39201-6402
US

IV. Provider business mailing address

P.O. BOX 3007
JACKSON MS
39207
US

V. Phone/Fax

Practice location:
  • Phone: 601-355-3889
  • Fax: 601-355-3885
Mailing address:
  • Phone: 601-355-3889
  • Fax: 601-355-3885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateMS

VIII. Authorized Official

Name: MRS. WILLIE JONES
Title or Position: PRESIDENT
Credential:
Phone: 601-355-3889