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General NPI Number Information
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NPI Number | 1184165169
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Entity Type | Organization
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Legal Business Name | ALEXANDER, VINCENT & ALEXANDRIA LLC
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Dates
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Enumeration Date | 03/10/2017
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Last Update Date | 03/10/2017
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Provider Practice Location Address
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Address Line | 219 FORD AVE
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City | JACKSON
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State | MS
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Zip | 39209-3322
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Country | US
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Telephone | 662-299-7236
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Fax | 769-524-4208
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Provider Business Mailing Address
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Address Line | 4795 MCWILLIE DR
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City | JACKSON
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State | MS
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Zip | 39206-5628
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Country | US
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Telephone | 769-524-4191
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Fax | 769-524-4208
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Authorized Official
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Title or Position | CEO
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Name | PEGGY LOUISE CLAYBORNE
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Credential |
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Telephone | 662-299-7236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 09603294
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License Number State | MS
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