Provider Demographics
NPI:1023008455
Name:SOUTH MISSISSIPPI HOME HEALTH, INC. REGION III DBA DEACONESS HOMECARE
Entity Type:Organization
Organization Name:SOUTH MISSISSIPPI HOME HEALTH, INC. REGION III DBA DEACONESS HOMECARE
Other - Org Name:DEACONESS HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:C
Authorized Official - Last Name:JAKUS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, MBA
Authorized Official - Phone:601-268-1842
Mailing Address - Street 1:PO BOX 16929
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-6929
Mailing Address - Country:US
Mailing Address - Phone:601-268-1842
Mailing Address - Fax:601-268-7898
Practice Address - Street 1:307 W MINNESOTA PARK RD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-6148
Practice Address - Country:US
Practice Address - Phone:985-429-1380
Practice Address - Fax:985-429-1344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1007251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1406732Medicaid
LA1406732Medicaid