=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407470321
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOD'S GIFTS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2020
-----------------------------------------------------
Last Update Date | 06/05/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 635 NAKOMA DR
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39206-3335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-540-0725
-----------------------------------------------------
Fax | 769-524-4426
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 68934
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39286-8934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-540-0725
-----------------------------------------------------
Fax | 767-524-4426
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. MONIECA MICHELLE MCNAIR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-540-0725
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------