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Contact Information

MISSISSIPPI HOMECARE OF JACKSON, LLC
817 EAST RIVER PLACE
SUITE 201
JACKSON, MS39202
 Phone: 601-352-5063
 Fax: 601-352-7098
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Home Health

251E00000X A4[11] Home Health Agency
Indicates primary specialty

NPI Profile & details for MISSISSIPPI HOMECARE OF JACKSON, LLC

NPI Number 1053423509
LBN Legal business name MISSISSIPPI HOMECARE OF JACKSON, LLC
Authorized official PETER NOVEMBER - (EXECUTIVE VICE PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 08/31/2006
Last updated 10/23/2009 - About 17 years ago
Identifiers
MS License # 1294
MS Medicaid 00770125
MS Other 70265 BLUE CROSS BLUE SHIELD OF
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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