Healthcare Provider Details

I. General information

NPI: 1861040586
Provider Name (Legal Business Name): SIMPLICITY HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BUSH HOLEMAN RD
SUNFLOWER MS
38778-9789
US

IV. Provider business mailing address

100 BUSH HOLEMAN RD
SUNFLOWER MS
38778-9789
US

V. Phone/Fax

Practice location:
  • Phone: 662-347-6584
  • Fax:
Mailing address:
  • Phone: 662-347-6584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: JEANETTE MARTIN-SMITH
Title or Position: OWNER
Credential:
Phone: 662-347-6584