Healthcare Provider Details

I. General information

NPI: 1578357521
Provider Name (Legal Business Name): QUALITY SENIOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5267 OLD HIGHWAY 11 # D1
HATTIESBURG MS
39402-8859
US

IV. Provider business mailing address

5267 OLD HIGHWAY 11 # D1
HATTIESBURG MS
39402-8859
US

V. Phone/Fax

Practice location:
  • Phone: 601-436-2279
  • Fax:
Mailing address:
  • Phone: 601-436-2279
  • Fax: 833-732-5592

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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: KISHINA JOHNSON
Title or Position: CO-OWNER
Credential: LPN
Phone: 601-436-2279