Southwest Development Corporation, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

7181 Issued in MS

Legal business name

SOUTHWEST DEVELOPMENT CORPORATION, INC.

Doing business as

Medgar Evers Home Health Agency

Practice address

210 Gilchrist Street
Fayette, MS 39069-0699

Phone

(601) 786-3955

Fax

(601) 786-9814

NPI assigned

Oct 19, 2006

Last updated

Jun 10, 2009By 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

Ms. Mary T. Irving

Title

Administrator

Phone

(601) 786-3955

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Medgar Evers Home Health Agency Doing business as

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244592000000",
    "number": "1841372976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 699",
            "city": "FAYETTE",
            "state": "MS",
            "postal_code": "390690699",
            "telephone_number": "601-786-3955",
            "fax_number": "601-786-9814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 GILCHRIST STREET",
            "city": "FAYETTE",
            "state": "MS",
            "postal_code": "390690699",
            "telephone_number": "601-786-3955",
            "fax_number": "601-786-9814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST DEVELOPMENT CORPORATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2009-06-10",
        "status": "A",
        "authorized_official_last_name": "IRVING",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-786-3955",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MS",
            "license": "7181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOMEMAKERS SERVICES",
            "identifier": "00770619",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00770119",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medgar Evers Home Health Agency",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Safe Haven Home
• Shenelle Savage, CNA
• Angela Short, LCSW
• Southwest Development Corporation, Inc. (Medgar Evers Respite Care)
• Southwest Development Corporation, Inc. (Medgar Evers Hospice)
• Southwest Development Corporation, Inc. (Medgar Evers Solutions)
• Derryin Ninaye Stampley, CPS
• Faith Stampley
• Kanayo Ugboaja
• Edna Fells Wallace, LPN

• Home Health Agency in Fayette, MS
• Providers in Fayette, 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 Jun 10, 2009; 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.