Healthcare Provider Details

I. General information

NPI: 1528719846
Provider Name (Legal Business Name): MIDSOUTH HAPPY LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 MAIN ST STE A
MONTICELLO MS
39654-3702
US

IV. Provider business mailing address

PO BOX 606
MONTICELLO MS
39654-0606
US

V. Phone/Fax

Practice location:
  • Phone: 601-806-5053
  • Fax: 351-205-1434
Mailing address:
  • Phone: 601-806-5053
  • Fax: 351-205-1434

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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY KATINA HALEY
Title or Position: OWNER
Credential:
Phone: 601-754-3978