Provider Demographics
NPI:1306182274
Name:ON CALL NURSING AGENCY
Entity Type:Organization
Organization Name:ON CALL NURSING AGENCY
Other - Org Name:NA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:601-218-8930
Mailing Address - Street 1:310 CAIN RIDGE RD
Mailing Address - Street 2:A7
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-6054
Mailing Address - Country:US
Mailing Address - Phone:601-218-8930
Mailing Address - Fax:
Practice Address - Street 1:310 CAIN RIDGE RD
Practice Address - Street 2:A7
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-6054
Practice Address - Country:US
Practice Address - Phone:601-218-8930
Practice Address - Fax:601-218-8930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR870313251E00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health