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General NPI Number Information
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NPI Number | 1033937552
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Entity Type | Organization
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Legal Business Name | PRIDE HOME HEALTH CARE SERVICES LLC
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 2615 LINCOLN RD
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City | HATTIESBURG
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State | MS
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Zip | 39402-3132
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Country | US
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Telephone | 601-307-0216
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Fax |
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Provider Business Mailing Address
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Address Line | 2615 LINCOLN RD
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City | HATTIESBURG
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State | MS
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Zip | 39402-3132
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Country | US
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Telephone | 601-307-0216
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LESLIA BAKER
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Credential |
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Telephone | 601-307-0216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #7
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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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