Mid-Delta Home Health of Charleston, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

7588 Issued in MS

Legal business name

MID-DELTA HOME HEALTH OF CHARLESTON, INC.

Practice address

617 N State St
Clarksdale, MS 38614-6517

Phone

(662) 624-4910

Fax

(662) 247-4924

NPI assigned

Jul 12, 2006

Last updated

May 8, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Clara T. Reed, RN

Title

Ceo

Phone

(662) 247-1254

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Arden Home Health of North Mississippi LLC

  • Home Health Agency
  • Oxford, MS
  • NPI 1093555344

  Sold to, 2024-05-01

  CMS change of ownership

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525737600000",
    "number": "1457376360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 373",
            "city": "BELZONI",
            "state": "MS",
            "postal_code": "390380373",
            "telephone_number": "662-247-1254",
            "fax_number": "662-247-4924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 N STATE ST",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386146517",
            "telephone_number": "662-624-4910",
            "fax_number": "662-247-4924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-DELTA HOME HEALTH OF CHARLESTON, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2018-05-08",
        "status": "A",
        "authorized_official_last_name": "REED",
        "authorized_official_first_name": "CLARA",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-247-1254",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MS",
            "license": "7588",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "70645",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "770448",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "70507",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "770387",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121587",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "640718392A",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mississippi Emergency Physician Services, LLC
• Mississippi State Department of Health

• Home Health Agency in Clarksdale, MS
• Providers in Clarksdale, MS by specialty
• Home Health Agency in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.