Healthcare Provider Details

I. General information

NPI: 1487196853
Provider Name (Legal Business Name): WASHINGTON HOME HEALTH AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3402 WISCONSIN AVE STE 10
VICKSBURG MS
39180-5378
US

IV. Provider business mailing address

3402 WISCONSIN AVE STE 10
VICKSBURG MS
39180-5378
US

V. Phone/Fax

Practice location:
  • Phone: 601-218-7280
  • Fax:
Mailing address:
  • Phone: 601-218-7280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateMS

VIII. Authorized Official

Name: MS. NATASHA NICOLE WASHINGTON
Title or Position: OWNER
Credential:
Phone: 601-218-7280