Healthcare Provider Details

I. General information

NPI: 1922385137
Provider Name (Legal Business Name): B1 NURSING CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 BOXWOOD CIR
BRANDON MS
39047-8006
US

IV. Provider business mailing address

208 BOXWOOD CIR
BRANDON MS
39047-8006
US

V. Phone/Fax

Practice location:
  • Phone: 601-307-5888
  • Fax:
Mailing address:
  • Phone: 601-307-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberP324428
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. MAKEBA C WHITE
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 601-307-5888