Provider Demographics
NPI:1184263956
Name:IN-HOME RESPITE BY ALEXANDER VINCENT & ALEXANDRIA LLC
Entity type:Organization
Organization Name:IN-HOME RESPITE BY ALEXANDER VINCENT & ALEXANDRIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAYBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-299-7236
Mailing Address - Street 1:106 LUCKETT ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-3414
Mailing Address - Country:US
Mailing Address - Phone:662-455-7233
Mailing Address - Fax:662-455-7234
Practice Address - Street 1:4795 MCWILLIE DR STE 105
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-5628
Practice Address - Country:US
Practice Address - Phone:769-524-4191
Practice Address - Fax:769-524-4208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care