Provider Demographics
NPI:1598379323
Name:HOME CARE OF MISSISSIPPI, LLC
Entity Type:Organization
Organization Name:HOME CARE OF MISSISSIPPI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-682-8600
Mailing Address - Street 1:999 REDDOCH CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3614
Mailing Address - Country:US
Mailing Address - Phone:901-682-8600
Mailing Address - Fax:
Practice Address - Street 1:428 N LAMAR BLVD STE 114
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-3221
Practice Address - Country:US
Practice Address - Phone:662-238-3340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care