Healthcare Provider Details

I. General information

NPI: 1609781707
Provider Name (Legal Business Name): SOLECARE MEDICAL FOOT SPA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 HARBOUR POINTE XING STE 301
RIDGELAND MS
39157-1152
US

IV. Provider business mailing address

105 BRIDGETON CIR
CANTON MS
39046-5107
US

V. Phone/Fax

Practice location:
  • Phone: 601-955-3562
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: ALISCIA SIMON
Title or Position: REGISTERED NURSE/OWNER
Credential: RN
Phone: 601-955-3562