MEDICARE: CDS HOME CARE, INC

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	332B00000X	Durable Medical Equipment & Medical Supplies	04960/02.2	MS
2	3336H0001X	Home Infusion Therapy Pharmacy	04960/02.2	MS
3	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	04960/02.2	MS
4	332BX2000X	Oxygen Equipment & Supplies (DME)	04960/02.2	MS
5	3336L0003X	Long Term Care Pharmacy	04960/02.2	MS
6	3336S0011X	Specialty Pharmacy	04960/02.2	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2520395	OTHER	MS	NCPDP NUMBER

General Provider Information

NPI Number	:	1225004948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CDS HOME CARE, INC

Provider Business Mailing Address
First Line	:	119 BOBO DR
Second Line	:
City	:	CRYSTAL SPRINGS
State	:	MS
Zip	:	39059
Country	:	US
Telephone Number	:	601-892-9988
Fax Number	:	601-892-9983

Provider Business Practice Location Address
First Line	:	119 BOBO DR
Second Line	:
City	:	CRYSTAL SPRINGS
State	:	MS
Zip	:	39059
Country	:	US
Telephone Number	:	601-892-9988
Fax Number	:	601-892-9983

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. REAGAN LINDSAY BROWN
Credential	:	RPH
Telephone Number	:	601-892-9988

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	09/11/2025

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Directions to “CDS HOME CARE, INC ” Practice Location

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