Provider Demographics
NPI:1225413966
Name:COMBINED PERSONAL CARE SERVICES
Entity Type:Organization
Organization Name:COMBINED PERSONAL CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATIVE SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERISH
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:601-214-4664
Mailing Address - Street 1:5260 CEDAR PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-4131
Mailing Address - Country:US
Mailing Address - Phone:601-397-6575
Mailing Address - Fax:769-251-2774
Practice Address - Street 1:5260 CEDAR PARK DR STE A
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4131
Practice Address - Country:US
Practice Address - Phone:601-397-6575
Practice Address - Fax:769-251-2774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty