MEDICARE: SERVING COMMUNITIES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker		MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013134022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERVING COMMUNITIES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 276
Second Line	:
City	:	HOLLANDALE
State	:	MS
Zip	:	38748-0276
Country	:	US
Telephone Number	:	662-827-2765
Fax Number	:	662-827-5001

Provider Business Practice Location Address
First Line	:	204 E AVE SOUTH
Second Line	:
City	:	HOLLANDALE
State	:	MS
Zip	:	38748
Country	:	US
Telephone Number	:	662-827-2765
Fax Number	:	662-827-5001

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. JUSTIN HENRY EIFLING
Credential	:
Telephone Number	:	662-827-2765

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	08/22/2020

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Directions to “SERVING COMMUNITIES, LLC ” Practice Location

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