Provider Demographics
NPI:1710983887
Name:HOME HEALTH CARE AFFILIATES OF MISSISSIPPI, INC.
Entity Type:Organization
Organization Name:HOME HEALTH CARE AFFILIATES OF MISSISSIPPI, INC.
Other - Org Name:CENTERWELL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED SIGNATORY
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-983-2273
Mailing Address - Street 1:6330 SPRINT PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1157
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 S. PONTOTOC DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:BRUCE
Practice Address - State:MS
Practice Address - Zip Code:38915-9533
Practice Address - Country:US
Practice Address - Phone:662-983-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOME HEALTH CARE AFFILIATES OF MISSISSIPPI, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-23
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000070662OtherBLUE CROSS
MS0770326Medicaid
MS000070662OtherBLUE CROSS