Healthcare Provider Details

I. General information

NPI: 1770127003
Provider Name (Legal Business Name): SACRED HEARTS HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 JEFFERSON STREET SUITE C
MONTICELLO MS
39654-3965
US

IV. Provider business mailing address

PO BOX 308
SILVER CREEK MS
39663-0308
US

V. Phone/Fax

Practice location:
  • Phone: 601-806-5088
  • Fax: 601-806-5089
Mailing address:
  • Phone: 601-806-5088
  • Fax: 601-806-5089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. JENNIFER LASHON MAY
Title or Position: OWNER
Credential:
Phone: 601-806-5088