Healthcare Provider Details

I. General information

NPI: 1528387859
Provider Name (Legal Business Name): BRANDI'S HOPE COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720B 3RD AVE SW
MAGEE MS
39111
US

IV. Provider business mailing address

720B 3RD AVE SW
MAGEE MS
39111
US

V. Phone/Fax

Practice location:
  • Phone: 601-721-3496
  • Fax:
Mailing address:
  • Phone: 601-721-3496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberBRANDI'S HOPE-BMR-01
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberBRANDI'S HOPE-BMR-01
License Number StateMS

VIII. Authorized Official

Name: MR. DANNY OWEN COWART
Title or Position: PRESIDENT/CEO
Credential:
Phone: 601-721-3496