Provider Demographics
NPI:1649295684
Name:MID-DELTA HOME HEALTH, INC.
Entity type:Organization
Organization Name:MID-DELTA HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:T
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:662-247-1254
Mailing Address - Street 1:405 N HAYDEN ST
Mailing Address - Street 2:
Mailing Address - City:BELZONI
Mailing Address - State:MS
Mailing Address - Zip Code:39038-3639
Mailing Address - Country:US
Mailing Address - Phone:662-247-1254
Mailing Address - Fax:662-247-4924
Practice Address - Street 1:405 N HAYDEN ST
Practice Address - Street 2:
Practice Address - City:BELZONI
Practice Address - State:MS
Practice Address - Zip Code:39038-3639
Practice Address - Country:US
Practice Address - Phone:662-247-1254
Practice Address - Fax:662-247-4924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS7488251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS770387Medicaid
MS70543Medicaid
MS70619OtherBLUE CROSS
MS770448Medicaid
MN121587Medicaid
MS25Q7115004Medicare ID - Type UnspecifiedLEXINGTON
MS25Q7115006Medicare ID - Type UnspecifiedGREENWOOD
MS70543Medicaid
MN121587Medicaid
MS70619OtherBLUE CROSS
MS257115Medicare ID - Type UnspecifiedPARENT
MS70543Medicare ID - Type UnspecifiedMEDICAID WAVER
MS770387Medicaid