Healthcare Provider Details

I. General information

NPI: 1306259981
Provider Name (Legal Business Name): LOSE/CONTROL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4795 I 55 N BUILDING B
JACKSON MS
39206-5602
US

IV. Provider business mailing address

PO BOX 6244
PEARL MS
39288-6244
US

V. Phone/Fax

Practice location:
  • Phone: 601-316-9989
  • Fax:
Mailing address:
  • Phone: 601-316-9989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberR879573
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateMS

VIII. Authorized Official

Name: MS. JOYCELYN YOLANDA COLEMAN
Title or Position: PRESIDENT/CEO
Credential: BS,MPPA
Phone: 601-316-9989