Healthcare Provider Details

I. General information

NPI: 1821605189
Provider Name (Legal Business Name): M&R PERSONAL CARE SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 CARRIAGE LN
FLORENCE MS
39073-6015
US

IV. Provider business mailing address

124 CARRIAGE LN
FLORENCE MS
39073-6015
US

V. Phone/Fax

Practice location:
  • Phone: 601-502-5474
  • Fax:
Mailing address:
  • Phone: 601-502-5474
  • 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: RHONDA JOHNSON
Title or Position: OWNER
Credential:
Phone: 601-502-5474