Healthcare Provider Details

I. General information

NPI: 1013521053
Provider Name (Legal Business Name): SHIRLEY HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 POPLAR SPRINGS DRIVE
MERIDIAN MS
39305
US

IV. Provider business mailing address

4525 POPLAR SPRINGS DRIVE
MERIDIAN MS
39305
US

V. Phone/Fax

Practice location:
  • Phone: 601-286-3242
  • Fax: 601-453-5004
Mailing address:
  • Phone: 601-286-3242
  • Fax: 601-453-5004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: CHARRISA SHIRLEY
Title or Position: OWNER
Credential:
Phone: 601-286-3242