Healthcare Provider Details

I. General information

NPI: 1871089797
Provider Name (Legal Business Name): LEVON DANIELS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 BROADWAY ST APT K7
CLINTON MS
39056-4842
US

IV. Provider business mailing address

160 BROADWAY ST APT K7
CLINTON MS
39056-4842
US

V. Phone/Fax

Practice location:
  • Phone: 601-951-8466
  • Fax:
Mailing address:
  • Phone: 601-951-8466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: