=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689032724
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEST CARE NURSING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2016
-----------------------------------------------------
Last Update Date | 02/03/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2315 MCFADDEN RD APT 1504
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39204-5281
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-397-0736
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2315 MCFADDEN RD APT 1504
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39204-5281
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-213-8441
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | MISS VALENCIA LARENZIA VAUGHN
-----------------------------------------------------
Credential | CEO
-----------------------------------------------------
Telephone | 601-397-0736
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | A0060372
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------