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General NPI Number Information
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NPI Number | 1265723118
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Entity Type | Organization
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Legal Business Name | HEALING HANDS HOMECARE LLC
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Dates
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Enumeration Date | 04/27/2011
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 704 WALNUT ST 704 WALNUT STREET
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City | HATTIESBURG
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State | MS
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Zip | 39401-4374
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Country | US
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Telephone | 601-307-2087
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Fax |
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Provider Business Mailing Address
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Address Line | 704 WALNUT ST 704 WALNUT STREET
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City | HATTIESBURG
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State | MS
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Zip | 39401-4374
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Country | US
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Telephone | 601-307-2087
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER NIKKI COOPER
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Credential | RN
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Telephone | 601-307-2087
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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 | R867038
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License Number State | MS
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