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General NPI Number Information
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NPI Number | 1013534650
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Entity Type | Organization
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Legal Business Name | RANDOLPH'S DEVOTED HOME CARE
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Dates
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Enumeration Date | 06/30/2020
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Last Update Date | 11/20/2020
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Provider Practice Location Address
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Address Line | 6901 HIGHWAY 305 N STE F
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-2317
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Country | US
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Telephone | 901-347-7221
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Fax |
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Provider Business Mailing Address
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Address Line | 6901 HIGHWAY 305 N STE F
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-2317
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Country | US
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Telephone | 662-755-5066
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | BIANCA RICHMOND
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Credential |
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Telephone | 662-755-5066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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