Healthcare Provider Details

I. General information

NPI: 1659888998
Provider Name (Legal Business Name): AT HOME CARE COMMUNITY OUTREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 09/24/2026
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 CHURCH STREET
PORT GIBSON MS
39150-2108
US

IV. Provider business mailing address

306 CHURCH ST
PORT GIBSON MS
39150-2108
US

V. Phone/Fax

Practice location:
  • Phone: 601-437-5504
  • Fax: 601-437-5506
Mailing address:
  • Phone: 601-437-3524
  • Fax: 601-437-3570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. DOROTHY JEANETTE FELTON
Title or Position: CEO
Credential: RN
Phone: 601-437-5504