Healthcare Provider Details

I. General information

NPI: 1992374938
Provider Name (Legal Business Name): ALL AT HOME PERSONAL CARE AND RESPITE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1836 E LINCOLN RD SE
BROOKHAVEN MS
39601-8701
US

IV. Provider business mailing address

1836 E LINCOLN RD SE
BROOKHAVEN MS
39601-8701
US

V. Phone/Fax

Practice location:
  • Phone: 601-754-6987
  • Fax: 601-299-5362
Mailing address:
  • Phone: 601-754-6987
  • Fax: 601-299-5362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: THERESA LOU WHITE
Title or Position: CEO
Credential:
Phone: 601-754-6987