Provider Demographics
NPI:1740530559
Name:COMMUNITY HEALTHCARE CONNECTIONS PERSONAL CARE SERVICES
Entity type:Organization
Organization Name:COMMUNITY HEALTHCARE CONNECTIONS PERSONAL CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUMFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-599-0006
Mailing Address - Street 1:5128 OLD HIGHWAY 11 STE 10
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-6234
Mailing Address - Country:US
Mailing Address - Phone:601-599-0006
Mailing Address - Fax:601-599-0007
Practice Address - Street 1:5128 OLD HIGHWAY 11 STE 10
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-6234
Practice Address - Country:US
Practice Address - Phone:601-599-0006
Practice Address - Fax:601-599-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04734811Medicaid