Healthcare Provider Details

I. General information

NPI: 1487002176
Provider Name (Legal Business Name): MORGAN AND DRAKE HOME CARE AGENCY AND SECONDARY PREVENTION PROGRAM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5773 OLD CANTON RD
JACKSON MS
39211-3202
US

IV. Provider business mailing address

5773 OLD CANTON RD
JACKSON MS
39211-3202
US

V. Phone/Fax

Practice location:
  • Phone: 601-456-9894
  • Fax:
Mailing address:
  • Phone: 601-456-9894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: EUGENE JOSHUA MORGAN
Title or Position: COMMUNITY HEALTH WORKER /CEO
Credential: CCRP
Phone: 601-456-9894