Healthcare Provider Details

I. General information

NPI: 1255866059
Provider Name (Legal Business Name): PERSONAL TOUCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2017
Last Update Date: 04/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 CHIPPEWAH DR
LAUREL MS
39443-7413
US

IV. Provider business mailing address

614 CHIPPEWAH DR
LAUREL MS
39443-7413
US

V. Phone/Fax

Practice location:
  • Phone: 601-425-2731
  • Fax: 601-422-0727
Mailing address:
  • Phone: 601-425-2732
  • Fax: 601-422-0727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberR733788
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License NumberR733788
License Number StateMS

VIII. Authorized Official

Name: MICHELE ELIZABETH MILLSAP
Title or Position: OWNER
Credential: RN BSN CDFS TTS
Phone: 601-323-7433