Healthcare Provider Details

I. General information

NPI: 1609691963
Provider Name (Legal Business Name): HEALING HANDS REHABILITATION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 LEXINGTON DR STE J
GLUCKSTADT MS
39110-6646
US

IV. Provider business mailing address

105 LEXINGTON DR STE H
GLUCKSTADT MS
39110-6646
US

V. Phone/Fax

Practice location:
  • Phone: 601-910-7300
  • Fax: 601-910-7071
Mailing address:
  • Phone: 601-910-7300
  • Fax: 601-910-7071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: JASMINE MARTIN SMITH
Title or Position: MANAGING PARTNER
Credential:
Phone: 601-910-7300