Healthcare Provider Details

I. General information

NPI: 1356375687
Provider Name (Legal Business Name): GERIATRIC SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 NORTHTOWN DR SUITE 220
JACKSON MS
39211-3047
US

IV. Provider business mailing address

13 NORTHTOWN DR SUITE 220
JACKSON MS
39211-3047
US

V. Phone/Fax

Practice location:
  • Phone: 601-956-8276
  • Fax: 601-709-0832
Mailing address:
  • Phone: 601-956-8276
  • Fax: 601-709-0832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number05810/11.1
License Number StateMS

VIII. Authorized Official

Name: MRS. REBECCA H. SHELTON
Title or Position: VP
Credential:
Phone: 601-956-8276