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General NPI Number Information
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NPI Number | 1114619756
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Entity Type | Organization
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Legal Business Name | HEROIC HOME HEALTH
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Dates
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Enumeration Date | 05/23/2023
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 770 LAKELAND DR APT 137
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City | JACKSON
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State | MS
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Zip | 39216-4636
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Country | US
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Telephone | 769-348-8174
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Fax |
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Provider Business Mailing Address
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Address Line | 770 LAKELAND DR APT 137
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City | JACKSON
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State | MS
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Zip | 39216-4636
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Country | US
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Telephone | 769-348-8174
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Fax |
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Authorized Official
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Title or Position | MEDICAL ASSISTANT
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Name | INDIA WALKER
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Credential |
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Telephone | 176-934-8817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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