Provider Demographics
NPI:1104201771
Name:TOTAL HEALTHCARE NETWORK INC.
Entity Type:Organization
Organization Name:TOTAL HEALTHCARE NETWORK INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-307-6381
Mailing Address - Street 1:210 COOPER RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-4805
Mailing Address - Country:US
Mailing Address - Phone:601-307-6381
Mailing Address - Fax:769-572-7616
Practice Address - Street 1:210 COOPER RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-4805
Practice Address - Country:US
Practice Address - Phone:601-307-6381
Practice Address - Fax:769-572-7616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00553769Medicaid
MS00289005Medicaid