Healthcare Provider Details

I. General information

NPI: 1659502755
Provider Name (Legal Business Name): ABITACARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 23RD AVE SUITE B
MERIDIAN MS
39301-4027
US

IV. Provider business mailing address

1501 23RD AVE SUITE B
MERIDIAN MS
39301-4027
US

V. Phone/Fax

Practice location:
  • Phone: 877-229-1724
  • Fax: 877-229-1725
Mailing address:
  • Phone: 877-229-1724
  • Fax: 877-229-1725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number08206/01.1
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number0820611
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: BRAD GILCHRIST
Title or Position: COO
Credential:
Phone: 601-482-4003