=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346123130
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOMMA MILLS & DESCENDANTS HOME HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2025
-----------------------------------------------------
Last Update Date | 07/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 CHICK SPRINGS RD STE 201F
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29609-4965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-243-8087
-----------------------------------------------------
Fax | 864-243-8086
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 CHICK SPRINGS RD STE 201F
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29609-4965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-243-8087
-----------------------------------------------------
Fax | 864-243-8086
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGER
-----------------------------------------------------
Name | TOWALLA LETESA WALKERBLACK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 864-434-7342
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------