Organization
SOUTHERN HEALTHCARE AGENCY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JACKIE D. MCMILLAN (CEO)
(601) 933-0037
Entity
Organization
Contact information
Practice address
301 NEW POINTE, RIDGELAND, MS 39157-3904
(601) 933-0037
(601) 932-8468
Mailing address
301 NEW POINTE, RIDGELAND, MS 39157-3904
(601) 933-0037
(601) 932-8468
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
27 17 009C
MS
253Z00000X
In Home Supportive Care Agency
—
—
385H00000X
Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00118933
—
MS
05
—
00770283
—
MS
05
—
00770284
—
MS
Enumeration date
10/22/2007
Last updated
07/15/2020
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