Provider Demographics
NPI:1508906223
Name:NORTHEAST MISSISSIPPI COMMUNITY SERVICES, INC..
Entity Type:Organization
Organization Name:NORTHEAST MISSISSIPPI COMMUNITY SERVICES, INC..
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-728-2118
Mailing Address - Street 1:PO BOX 930
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-0930
Mailing Address - Country:US
Mailing Address - Phone:662-728-2118
Mailing Address - Fax:662-728-8720
Practice Address - Street 1:801 HATCHIE ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-4803
Practice Address - Country:US
Practice Address - Phone:662-728-2118
Practice Address - Fax:662-728-8720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07178254Medicaid
MS00770067Medicaid
MS07736553Medicaid