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General NPI Number Information
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NPI Number | 1841103157
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Entity Type | Organization
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Legal Business Name | LIFE CONSTRUCTION OUTREACH
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Dates
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Enumeration Date | 09/26/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 241 N MAIN ST
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City | PETAL
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State | MS
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Zip | 39465-2349
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Country | US
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Telephone | 601-596-2105
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Fax |
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Provider Business Mailing Address
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Address Line | 241 N MAIN ST
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City | PETAL
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State | MS
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Zip | 39465-2349
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | RHONDA JACKSON
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Credential |
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Telephone | 601-596-2105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | NULL
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