Provider Demographics
NPI:1003596008
Name:CARE AT HOME MISSISSIPPI
Entity Type:Organization
Organization Name:CARE AT HOME MISSISSIPPI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-563-0295
Mailing Address - Street 1:1810 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4068
Mailing Address - Country:US
Mailing Address - Phone:847-563-0295
Mailing Address - Fax:847-563-3331
Practice Address - Street 1:7 PROFESSIONAL PKWY STE 101
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-2648
Practice Address - Country:US
Practice Address - Phone:847-563-0295
Practice Address - Fax:847-563-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care