Healthcare Provider Details

I. General information

NPI: 1548890858
Provider Name (Legal Business Name): DAVIS HEALTHCARE FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2020
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6735 I 55 S STE 2A
BYRAM MS
39272-9162
US

IV. Provider business mailing address

413 PARKER DR
CLINTON MS
39056-4519
US

V. Phone/Fax

Practice location:
  • Phone: 601-372-3066
  • Fax:
Mailing address:
  • Phone: 601-668-4354
  • Fax:

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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: PAMELA DAVIS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: REGISTERED NURSE
Phone: 601-668-4354