Healthcare Provider Details

I. General information

NPI: 1841676699
Provider Name (Legal Business Name): AUSTIN'S HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 TERESA DR
JACKSON MS
39212-2758
US

IV. Provider business mailing address

PO BOX 5914
PEARL MS
39288-5914
US

V. Phone/Fax

Practice location:
  • Phone: 601-213-9424
  • Fax:
Mailing address:
  • Phone: 601-213-9424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: LORRINE MAYES
Title or Position: OWNER
Credential:
Phone: 601-213-9424