Healthcare Provider Details

I. General information

NPI: 1073105334
Provider Name (Legal Business Name): BRANCH OF LOVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 01/10/2026
Certification Date: 01/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 ELM ST
LAUREL MS
39440-4545
US

IV. Provider business mailing address

150 ELM ST
LAUREL MS
39440-4545
US

V. Phone/Fax

Practice location:
  • Phone: 601-498-8132
  • Fax: 207-690-9382
Mailing address:
  • Phone: 601-498-8132
  • Fax: 207-690-9382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. LADONNA PHILLIPS
Title or Position: NURSE PRACTITIONER
Credential: DNP, AGNP-C, PMHNP-B
Phone: 601-498-8132