Provider Demographics
NPI:1043706765
Name:NOXUBEE COUNTY HUMAN RESOURCES AGENCY
Entity type:Organization
Organization Name:NOXUBEE COUNTY HUMAN RESOURCES AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TONETTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-726-9640
Mailing Address - Street 1:149 WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MS
Mailing Address - Zip Code:39341-2648
Mailing Address - Country:US
Mailing Address - Phone:662-726-9640
Mailing Address - Fax:662-726-9642
Practice Address - Street 1:149 WAYNE ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MS
Practice Address - Zip Code:39341-2648
Practice Address - Country:US
Practice Address - Phone:662-726-9640
Practice Address - Fax:662-726-9642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS343900000X
MS000000343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)