1801256318 NPI number — CARING HANDS PPEC OF VICKSBURG

Table of content: (NPI 1801256318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801256318 NPI number — CARING HANDS PPEC OF VICKSBURG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARING HANDS PPEC OF VICKSBURG
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:
Provider Other Organization Name Type Code:
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:
1801256318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2403
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71207-2403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-323-1930
Provider Business Mailing Address Fax Number:
318-323-1013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3419 WISCONSIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VICKSBURG
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39180-5330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-629-0505
Provider Business Practice Location Address Fax Number:
601-629-0502
Provider Enumeration Date:
02/25/2016

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
BARBIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER, RN
Authorized Official Telephone Number:
318-323-1930

Provider Taxonomy Codes

  • Taxonomy code: 261QM3000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 005574549 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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