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General NPI Number Information
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NPI Number | 1710382619
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Entity Type | Organization
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Legal Business Name | PATRIOT HOME CARE
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Dates
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Enumeration Date | 11/04/2014
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Last Update Date | 01/13/2016
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Provider Practice Location Address
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Address Line | 324 MANGUM AVE
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City | MENDENHALL
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State | MS
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Zip | 39114-3015
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Country | US
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Telephone | 601-675-7100
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Fax | 601-675-7007
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Provider Business Mailing Address
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Address Line | 324 MANGUM AVE
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City | MENDENHALL
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State | MS
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Zip | 39114-3015
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Country | US
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Telephone | 601-675-7100
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Fax | 601-675-7007
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Authorized Official
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Title or Position | OWNER
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Name | MS. JAYTORIA MARQUITA-KADESHIA WILKINS
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Credential |
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Telephone | 601-896-1644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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