Provider Demographics
NPI:1194488007
Name:SOS TRANSITIONAL LIVING SERVICES, LLC
Entity Type:Organization
Organization Name:SOS TRANSITIONAL LIVING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICKETIA
Authorized Official - Middle Name:ESTELLA
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-441-2220
Mailing Address - Street 1:2008 S 28TH AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-3450
Mailing Address - Country:US
Mailing Address - Phone:601-441-2220
Mailing Address - Fax:601-602-1059
Practice Address - Street 1:214 BROADWAY DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-5084
Practice Address - Country:US
Practice Address - Phone:601-441-2220
Practice Address - Fax:601-602-1059
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOS TRANSITIONAL LIVING SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No174200000XOther Service ProvidersMeals
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)