Healthcare Provider Details

I. General information

NPI: 1851915383
Provider Name (Legal Business Name): 180 INTERVENTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 WILLOW RIDGE DR
PONTOTOC MS
38863-8950
US

IV. Provider business mailing address

52 WILLOW RIDGE DR
PONTOTOC MS
38863-8950
US

V. Phone/Fax

Practice location:
  • Phone: 662-308-7020
  • Fax:
Mailing address:
  • Phone: 662-308-7020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGIE GARRETT
Title or Position: OWNER
Credential:
Phone: 662-308-7020