Healthcare Provider Details

I. General information

NPI: 1356541841
Provider Name (Legal Business Name): HEALTH CARE MEDICAL RESPIRATORY & REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

371 TOWNE CENTER BLVD
RIDGELAND MS
39157-4833
US

IV. Provider business mailing address

371 TOWNE CENTER BLVD
RIDGELAND MS
39157-4833
US

V. Phone/Fax

Practice location:
  • Phone: 601-420-0064
  • Fax: 601-420-0223
Mailing address:
  • Phone: 601-420-0064
  • Fax: 601-420-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0586411.1
License Number StateMS

VIII. Authorized Official

Name: MRS. VALERIE HARDEN TOLLEY
Title or Position: PRESIDENT
Credential:
Phone: 601-720-0064