Organization
MISSISSIPPI HOMECARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD D. STELLY (PRESIDENT)
(337) 233-1307
Entity
Organization
Contact information
Practice address
2080 S FRONTAGE RD STE 107, VICKSBURG, MS 39180-5882
(601) 629-0015
(601) 629-0046
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
3581
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0770602
—
MS
01
—
70757
BLUE CROSS BLUE SHIELD OF
MS
Enumeration date
08/31/2006
Last updated
03/09/2018
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