Provider Demographics
NPI:1316318264
Name:DEPENDABLE SOURCE CORP. OF MS
Entity type:Organization
Organization Name:DEPENDABLE SOURCE CORP. OF MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-355-3889
Mailing Address - Street 1:P.O. BOX 3007
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39207
Mailing Address - Country:US
Mailing Address - Phone:601-355-3889
Mailing Address - Fax:601-355-3885
Practice Address - Street 1:1840 S WEST ST
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39201-6402
Practice Address - Country:US
Practice Address - Phone:601-355-3889
Practice Address - Fax:601-355-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS253Z00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03151797Medicaid
MS00785801Medicaid