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General NPI Number Information
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NPI Number | 1194060921
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Entity Type | Organization
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Legal Business Name | CAREWELL PERSONAL CARE SERVICES, LLC
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Dates
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Enumeration Date | 12/05/2012
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 1524 ADELINE ST SUITE B
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City | HATTIESBURG
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State | MS
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Zip | 39401-6262
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Country | US
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Telephone | 601-620-7990
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 17822
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City | HATTIESBURG
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State | MS
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Zip | 39404-7822
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Country | US
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Telephone | 601-620-7990
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MRS. LETISCHA MCDYESS
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Credential |
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Telephone | 601-620-7990
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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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