Healthcare Provider Details

I. General information

NPI: 1174122733
Provider Name (Legal Business Name): BLESSING HEARTS PRIVATE DUTY HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 11/27/2020
Certification Date: 11/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N CHERRY ST
TYLERTOWN MS
39667-2308
US

IV. Provider business mailing address

105 N CHERRY ST
TYLERTOWN MS
39667-2308
US

V. Phone/Fax

Practice location:
  • Phone: 601-827-5107
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NUTRECIA THOMPSON
Title or Position: PRESIDENT
Credential:
Phone: 601-814-0060