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General NPI Number Information
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NPI Number | 1376152512
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Entity Type | Organization
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Legal Business Name | JACKSON MS HOMECARE
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 2625 RIDGEWOOD RD STE 104
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City | JACKSON
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State | MS
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Zip | 39216-4900
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Country | US
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Telephone | 601-500-5027
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Fax | 601-500-7344
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Provider Business Mailing Address
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Address Line | 2625 RIDGEWOOD RD STE 104
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City | JACKSON
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State | MS
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Zip | 39216-4900
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Country | US
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Telephone | 601-500-5027
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Fax | 601-500-7344
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CLIFTON REESE DANIELS
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Credential |
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Telephone | 601-500-5027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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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 | 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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