Healthcare Provider Details

I. General information

NPI: 1164350534
Provider Name (Legal Business Name): LILLY PAD HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MILLCREEK CORS STE B
BRANDON MS
39047-9011
US

IV. Provider business mailing address

103 MILLCREEK CORS STE B
BRANDON MS
39047-9011
US

V. Phone/Fax

Practice location:
  • Phone: 601-410-5836
  • Fax: 601-410-5836
Mailing address:
  • Phone: 601-410-5836
  • Fax: 601-410-5836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LATONYA HAILES
Title or Position: OWNER
Credential:
Phone: 601-410-5836