=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518675206
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RELIANCE HOME & COMMUNITY CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2022
-----------------------------------------------------
Last Update Date | 12/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 404 N FIR AVE STE B
-----------------------------------------------------
City | COLLINS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39428-4201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-765-5041
-----------------------------------------------------
Fax | 601-765-3247
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1781
-----------------------------------------------------
City | COLLINS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39428-1781
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-765-5041
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JESSICA WHITE
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 601-765-5041
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------