1275674533 NPI number — STA-HOME HEALTH AGENCY OF CARTHAGE, INC

Table of content: (NPI 1275674533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275674533 NPI number — STA-HOME HEALTH AGENCY OF CARTHAGE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STA-HOME HEALTH AGENCY OF CARTHAGE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ACCENTCARE HOME HEALTH OF CARTHAGE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275674533
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17855 DALLAS PKWY STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75287-6857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-201-3819
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
616 HIGHWAY 35 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARTHAGE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39051-5804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-267-8333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SISCEL
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
Authorized Official Title or Position:
VP LEGAL
Authorized Official Telephone Number:
601-267-8333

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  10985 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00770109 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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