Provider Demographics
NPI:1902871809
Name:CDS HOME CARE, INC.
Entity Type:Organization
Organization Name:CDS HOME CARE, INC.
Other - Org Name:CDS HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:REAGAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-883-2999
Mailing Address - Street 1:1911 MISSION 66
Mailing Address - Street 2:SUITE H
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-3762
Mailing Address - Country:US
Mailing Address - Phone:601-883-2999
Mailing Address - Fax:601-883-2877
Practice Address - Street 1:1911 MISSION 66
Practice Address - Street 2:SUITE H
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-3762
Practice Address - Country:US
Practice Address - Phone:601-883-2999
Practice Address - Fax:601-883-2877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05542/02.2332B00000X, 332BP3500X, 332BX2000X, 3336H0001X, 3336L0003X
MS3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Not Answered3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Not Answered3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Not Answered3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440953Medicaid
MS2521652OtherNCPDP
MS00330687Medicaid
MS00440953Medicaid