Provider Demographics
NPI:1013406172
Name:SOUTH CENTRAL COMMUNITY ACTION AGENCY, INC
Entity Type:Organization
Organization Name:SOUTH CENTRAL COMMUNITY ACTION AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:769-235-8224
Mailing Address - Street 1:PO BOX 6590
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39282-6590
Mailing Address - Country:US
Mailing Address - Phone:769-235-8224
Mailing Address - Fax:769-251-1017
Practice Address - Street 1:3891 I-55 SOUTH FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212
Practice Address - Country:US
Practice Address - Phone:769-235-8224
Practice Address - Fax:769-251-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)