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Organization
MISSISSIPPI HOMECARE OF JACKSON, LLC
Active
Organization
MISSISSIPPI HOMECARE OF JACKSON, LLC
Active
Other names
Mississippi HomeCare / Jackson
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER C. NOVEMBER II (EXECUTIVE VICE PRESIDENT)
(337) 233-1307
Entity
Organization
Contact information
Practice address
817 EAST RIVER PLACE, SUITE 201, JACKSON, MS 39202
(601) 352-5063
(601) 352-7098
Mailing address
PO BOX 51266, LAFAYETTE, LA 70505-1266
(337) 233-1307
(337) 233-5764
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
1294
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00770125
—
MS
01
—
70265
BLUE CROSS BLUE SHIELD OF
MS
Enumeration date
08/31/2006
Last updated
10/23/2009
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