Healthcare Provider Details

I. General information

NPI: 1023974110
Provider Name (Legal Business Name): MAGIC BROOM PERSONAL CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/01/2026
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3106 THIRD ST
NATCHEZ MS
39120-2704
US

IV. Provider business mailing address

3106 THIRD ST
NATCHEZ MS
39120-2704
US

V. Phone/Fax

Practice location:
  • Phone: 769-355-2224
  • Fax:
Mailing address:
  • Phone: 769-355-2224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AMANDA ANN KING
Title or Position: OWNER/ ADMINISTRATOR
Credential:
Phone: 769-355-2224