Healthcare Provider Details

I. General information

NPI: 1396662482
Provider Name (Legal Business Name): RICHARDSON SENIOR CARE OF JACKSON MISSISSIPPI, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 NORWICH DR
MADISON MS
39110-7771
US

IV. Provider business mailing address

809 NORWICH DR
MADISON MS
39110-7771
US

V. Phone/Fax

Practice location:
  • Phone: 801-910-2833
  • Fax:
Mailing address:
  • Phone: 801-910-2833
  • 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: WILLIAM TRENT RICHARDSON
Title or Position: OWNER
Credential:
Phone: 801-910-2833