Healthcare Provider Details

I. General information

NPI: 1053746487
Provider Name (Legal Business Name): ASSURANCE HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1549 SHILOH CHURCH RD
NEWTON MS
39345-9024
US

IV. Provider business mailing address

1549 SHILOH CHURCH RD
NEWTON MS
39345-9024
US

V. Phone/Fax

Practice location:
  • Phone: 601-818-4100
  • Fax:
Mailing address:
  • Phone: 601-818-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: ADREA SMITH
Title or Position: OWNER
Credential:
Phone: 601-818-4100