Healthcare Provider Details

I. General information

NPI: 1336787365
Provider Name (Legal Business Name): CARING HEARTS OF MISSISSIPPI NONPROFIT OUTREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 PINE ACRES LN
TERRY MS
39170-7628
US

IV. Provider business mailing address

740 FREEDOM RD
CENTURY FL
32535-2436
US

V. Phone/Fax

Practice location:
  • Phone: 601-291-6858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: ANGELA COLLINS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 866-969-5414