Healthcare Provider Details

I. General information

NPI: 1902871809
Provider Name (Legal Business Name): CDS HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 MISSION 66 SUITE H
VICKSBURG MS
39180-3762
US

IV. Provider business mailing address

1911 MISSION 66 SUITE H
VICKSBURG MS
39180-3762
US

V. Phone/Fax

Practice location:
  • Phone: 601-883-2999
  • Fax: 601-883-2877
Mailing address:
  • Phone: 601-883-2999
  • Fax: 601-883-2877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number05542/02.2
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number05542/02.2
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number05542/02.2
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number05542/02.2
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number05542/02.2
License Number StateMS
# 6
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number StateMS

VIII. Authorized Official

Name: MR. REAGAN L BROWN
Title or Position: PHARMACIST
Credential: RPH
Phone: 601-883-2999