Healthcare Provider Details

I. General information

NPI: 1144814120
Provider Name (Legal Business Name): JOSIAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2021
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 THOMAS ST
GREENVILLE MS
38703-6764
US

IV. Provider business mailing address

119 CATHERINE ST
GREENVILLE MS
38701-6206
US

V. Phone/Fax

Practice location:
  • Phone: 662-436-1030
  • Fax:
Mailing address:
  • Phone: 662-436-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: LACRYSTAL ZUKILYA WINDER
Title or Position: OWNER
Credential:
Phone: 662-436-1030