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General NPI Number Information
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NPI Number | 1841372976
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Entity Type | Organization
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Legal Business Name | SOUTHWEST DEVELOPMENT CORPORATION, INC.
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 06/10/2009
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Provider Practice Location Address
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Address Line | 210 GILCHRIST STREET
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City | FAYETTE
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State | MS
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Zip | 39069-0699
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Country | US
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Telephone | 601-786-3955
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Fax | 601-786-9814
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Provider Business Mailing Address
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Address Line | PO BOX 699
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City | FAYETTE
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State | MS
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Zip | 39069-0699
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Country | US
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Telephone | 601-786-3955
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Fax | 601-786-9814
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. MARY T. IRVING
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Credential |
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Telephone | 601-786-3955
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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 | 7181
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License Number State | MS
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