=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306408810
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HANDS IN CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2019
-----------------------------------------------------
Last Update Date | 07/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2109 19TH ST
-----------------------------------------------------
City | GULFPORT
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39501-2918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-342-7437
-----------------------------------------------------
Fax | 228-206-5478
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2109 19TH ST
-----------------------------------------------------
City | GULFPORT
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39501-2918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-342-7437
-----------------------------------------------------
Fax | 228-206-5478
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SHANITA GRAYER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 228-261-9497
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------