OrganizationActive
Extensions of Living, LLC
NPI 1477823169 · Homemaker · Hattiesburg, MS
Provider details
- NPI number
- 1477823169
- Entity type
- Organization
- Primary specialty
- HomemakerNursing Service Related Providers
- Organization subpart
- No
- Authorized official
- Vicki Jackson, Director(601) 582-4695
- License
- 07589517 (MS)
Specialties & taxonomies
Nursing Service Related Providers
Practice location
301 Humble Ave
Suite 174
Hattiesburg, MS 39401-6365
Phone: (601) 582-4695
Fax: (601) 582-8178
Approximate (ZIP-level) locationGet directions
Mailing address
301 Humble Ave
Hattiesburg, MS 39401-6365
Registry dates
- Enumerated
- 2012-01-11
- Last updated
- 2012-01-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.