Healthcare Provider Details

I. General information

NPI: 1467838995
Provider Name (Legal Business Name): SALUS HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13109 SHRINERS BLVD STE B
BILOXI MS
39532-8747
US

IV. Provider business mailing address

13109 SHRINERS BLVD STE B
BILOXI MS
39532-8747
US

V. Phone/Fax

Practice location:
  • Phone: 228-207-2515
  • Fax: 888-704-7978
Mailing address:
  • Phone: 228-207-2515
  • Fax: 888-704-7978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. BRYAN JOSEPH BOUDREAUX SR.
Title or Position: OWNER
Credential:
Phone: 228-207-2515