Healthcare Provider Details

I. General information

NPI: 1225750359
Provider Name (Legal Business Name): FIRST CARE 101K LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 LOUIS CARTER RD
HARRISVILLE MS
39082-4117
US

IV. Provider business mailing address

204 LOUIS CARTER RD
HARRISVILLE MS
39082-4117
US

V. Phone/Fax

Practice location:
  • Phone: 601-858-2056
  • Fax:
Mailing address:
  • Phone: 601-858-2056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY ANN SMITH
Title or Position: MANAGER
Credential:
Phone: 601-858-2056