Healthcare Provider Details

I. General information

NPI: 1942614219
Provider Name (Legal Business Name): ADAMS HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MOORE ST
PEARL MS
39208
US

IV. Provider business mailing address

225 MOORE ST
PEARL MS
39208
US

V. Phone/Fax

Practice location:
  • Phone: 601-942-6375
  • Fax:
Mailing address:
  • Phone: 601-942-6375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberR889314
License Number StateMS

VIII. Authorized Official

Name: MRS. TAMMIE JO ADAMS
Title or Position: SOLE PROPRIETOR
Credential: BSN, MBA
Phone: 601-942-6375