Healthcare Provider Details

I. General information

NPI: 1770382442
Provider Name (Legal Business Name): A LILLIE OF LOVE HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 OLD SALTILLO RD
SALTILLO MS
38866-5700
US

IV. Provider business mailing address

111 OLD SALTILLO RD
SALTILLO MS
38866-5700
US

V. Phone/Fax

Practice location:
  • Phone: 662-255-2970
  • Fax:
Mailing address:
  • Phone: 662-255-2970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: NYESHA GUYTON
Title or Position: OWNER
Credential: MHA
Phone: 662-255-2970