Healthcare Provider Details

I. General information

NPI: 1669087284
Provider Name (Legal Business Name): CONNECTIVE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

398 E MAIN ST STE 201
TUPELO MS
38804-4037
US

IV. Provider business mailing address

398 E MAIN ST STE 201
TUPELO MS
38804-4037
US

V. Phone/Fax

Practice location:
  • Phone: 662-446-6900
  • Fax:
Mailing address:
  • Phone: 662-446-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. RACHIEL LEANN BUCHANAN
Title or Position: OWNER/MANAGER
Credential: CNA
Phone: 662-446-6900