NPIMap

Organization Active NPI

Mississippi Homecare, LLC

  • Home Health Agency
  • Vicksburg, MS
National Provider Identifier
1497867857
Registry record updated Mar 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
3581 Issued in MS
Legal business name
MISSISSIPPI HOMECARE, LLC
Practice address
2080 S Frontage Rd Ste 107
Vicksburg, MS 39180-5882
Phone
(601) 629-0015
Fax
(601) 629-0046
NPI assigned
Aug 31, 2006
Last updated
Mar 9, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2018

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

Authorized official

Name
Mr. Donald D. Stelly
Title
President
Phone
(337) 233-1307

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 3581 MS Primary

Addresses

Primary practice location

2080 S Frontage Rd Ste 107
Vicksburg, MS 39180-5882

Mailing address

PO Box 51266
Lafayette, LA 70505-1266
Phone (337) 233-1307

Other identifiers 2

IdentifierTypeStateIssuer
0770602MedicaidMS
70757OtherMSBLUE CROSS BLUE SHIELD OF

National Provider Directory

National Provider Directory

Locations

406 Church St
#A
Port Gibson, MS 39150
Phone (601) 437-8201

615 Market St
Port Gibson, MS 39150
Phone (601) 437-8201

50 Frontage Rd
Rolling Fork, MS 39159
Phone (662) 873-4341

105 Thalweg Dr
#B
Vicksburg, MS 39183
Phone (601) 629-0015

123 E Jefferson St
Yazoo City, MS 39194
Phone (662) 746-8481

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520553600000",
    "number": "1497867857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51266",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705051266",
            "telephone_number": "337-233-1307",
            "fax_number": "337-233-5764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 S FRONTAGE RD STE 107",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391805882",
            "telephone_number": "601-629-0015",
            "fax_number": "601-629-0046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI HOMECARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2018-03-09",
        "status": "A",
        "authorized_official_last_name": "STELLY",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "337-233-1307",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MS",
            "license": "3581",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0770602",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF",
            "identifier": "70757",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vicksburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.