Healthcare Provider Details

I. General information

NPI: 1275325094
Provider Name (Legal Business Name): BLEDSOE PREMIER HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 W SOUTH ST
HERNANDO MS
38632-2265
US

IV. Provider business mailing address

165 W SOUTH ST
HERNANDO MS
38632-2265
US

V. Phone/Fax

Practice location:
  • Phone: 662-298-3164
  • Fax: 662-298-3219
Mailing address:
  • Phone: 662-298-3164
  • Fax: 662-298-3219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ALTHESIA BLEDSOE
Title or Position: DIRECTOR
Credential:
Phone: 662-298-3164