Provider Demographics
NPI:1376152512
Name:JACKSON MS HOMECARE
Entity Type:Organization
Organization Name:JACKSON MS HOMECARE
Other - Org Name:VISITING ANGELS JACKSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:REESE
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-500-5027
Mailing Address - Street 1:2625 RIDGEWOOD RD STE 104
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4900
Mailing Address - Country:US
Mailing Address - Phone:601-500-5027
Mailing Address - Fax:601-500-7344
Practice Address - Street 1:2625 RIDGEWOOD RD STE 104
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4900
Practice Address - Country:US
Practice Address - Phone:601-500-5027
Practice Address - Fax:601-500-7344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty