Healthcare Provider Details

I. General information

NPI: 1538080007
Provider Name (Legal Business Name): ALLIANCE HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7075 GOLDEN OAKS LOOP W STE 16
SOUTHAVEN MS
38671-9013
US

IV. Provider business mailing address

7075 GOLDEN OAKS LOOP W STE 16
SOUTHAVEN MS
38671-9013
US

V. Phone/Fax

Practice location:
  • Phone: 662-850-3566
  • Fax: 662-850-3530
Mailing address:
  • Phone: 662-850-3566
  • Fax: 662-850-3566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DERRIS JOYNER
Title or Position: CO-OWNER
Credential:
Phone: 662-850-3566