Healthcare Provider Details

I. General information

NPI: 1104702687
Provider Name (Legal Business Name): MIKEY'S MEMORY HCBS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18308 COMMISSION RD STE A
LONG BEACH MS
39560-2402
US

IV. Provider business mailing address

18308 COMMISSION RD STE A
LONG BEACH MS
39560-2402
US

V. Phone/Fax

Practice location:
  • Phone: 228-343-6734
  • Fax:
Mailing address:
  • Phone: 228-255-5755
  • Fax: 228-678-2348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM DODSON
Title or Position: FOUNDER/CEO
Credential: CNA, CCMA
Phone: 228-255-5755