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General NPI Number Information
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NPI Number | 1194488007
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Entity Type | Organization
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Legal Business Name | SOS TRANSITIONAL LIVING SERVICES, LLC
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Dates
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Enumeration Date | 10/18/2021
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Last Update Date | 10/18/2021
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Provider Practice Location Address
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Address Line | 214 BROADWAY DR
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City | HATTIESBURG
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State | MS
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Zip | 39401-5084
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Country | US
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Telephone | 601-441-2220
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Fax | 601-602-1059
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Provider Business Mailing Address
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Address Line | 2008 S 28TH AVENUE EXT
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City | HATTIESBURG
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State | MS
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Zip | 39402-3450
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Country | US
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Telephone | 601-441-2220
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Fax | 601-602-1059
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Authorized Official
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Title or Position | MANAGER, CEO
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Name | RICKETIA ESTELLA MCKENZIE
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Credential |
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Telephone | 601-441-2220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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