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General NPI Number Information
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NPI Number | 1063046902
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Entity Type | Organization
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Legal Business Name | EMBASSY HOME CARE, LLC
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Dates
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Enumeration Date | 03/01/2020
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Last Update Date | 03/01/2020
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Provider Practice Location Address
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Address Line | 298 COMMERCE PARK DR STE D
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City | RIDGELAND
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State | MS
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Zip | 39157-2237
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Country | US
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Telephone | 601-790-1260
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2209
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City | MADISON
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State | MS
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Zip | 39130-2209
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Country | US
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Telephone | 601-790-1260
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Fax | 601-605-7060
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Authorized Official
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Title or Position | CEO
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Name | MRS. LAWANDA L KIRKLAND
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Credential |
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Telephone | 601-790-1260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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