Healthcare Provider Details

I. General information

NPI: 1831861053
Provider Name (Legal Business Name): PURITY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 EASTHAVEN DR
CLINTON MS
39056-5319
US

IV. Provider business mailing address

123A HIGHWAY 80 E STE 229
CLINTON MS
39056-4738
US

V. Phone/Fax

Practice location:
  • Phone: 601-941-0556
  • Fax:
Mailing address:
  • Phone: 601-941-0556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MS. YVETTE FORTNER BUTLER
Title or Position: MANAGER
Credential: PCA
Phone: 601-941-0556