Healthcare Provider Details

I. General information

NPI: 1952097891
Provider Name (Legal Business Name): HALO EXPRESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1597 TICONDEROGA DR
SOUTHAVEN MS
38671-2107
US

IV. Provider business mailing address

PO BOX 793
HORN LAKE MS
38637-0793
US

V. Phone/Fax

Practice location:
  • Phone: 901-607-4182
  • Fax:
Mailing address:
  • Phone: 901-607-4182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHEILA K FRANKLIN
Title or Position: PRESIDENT
Credential:
Phone: 901-607-4182