Healthcare Provider Details

I. General information

NPI: 1902726904
Provider Name (Legal Business Name): PURPLE HEART HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4316 KNIGHTS LN
VICKSBURG MS
39180-8966
US

IV. Provider business mailing address

3442 HALLS FERRY RD
VICKSBURG MS
39180-5504
US

V. Phone/Fax

Practice location:
  • Phone: 601-529-9512
  • Fax:
Mailing address:
  • Phone: 601-529-9512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS BUSARI
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 601-529-9512