=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629897046
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXPRESS CARE SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2024
-----------------------------------------------------
Last Update Date | 10/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1959 BLOOMFIELD RD
-----------------------------------------------------
City | PRESTON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39354-8750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-562-6120
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1902 FRONT ST FRNT ST
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39301-5234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-562-6120
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MS. ROSHELL DENISE BOYD
-----------------------------------------------------
Credential | ETC
-----------------------------------------------------
Telephone | 601-562-6120
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------