Healthcare Provider Details

I. General information

NPI: 1477414423
Provider Name (Legal Business Name): AUSTINS LEGACY LLC DBA EXECUTIVE HOME CARE OF JACKSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 E CAPITOL ST
JACKSON MS
39201-3405
US

IV. Provider business mailing address

317 E CAPITOL ST STE 200
JACKSON MS
39201-3405
US

V. Phone/Fax

Practice location:
  • Phone: 601-281-8397
  • Fax:
Mailing address:
  • Phone: 601-281-8397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: KENNETH J AUSTIN
Title or Position: OWNER
Credential:
Phone: 601-906-2926