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General NPI Number Information
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NPI Number | 1720909385
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Entity Type | Organization
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Legal Business Name | FIRST CARE HOME HEATH AGENCY LLC
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Dates
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Enumeration Date | 07/21/2026
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Last Update Date | 07/21/2026
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Provider Practice Location Address
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Address Line | 714 HALBERT HEIGHTS RD STE C
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City | BROOKHAVEN
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State | MS
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Zip | 39601-3656
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Country | US
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Telephone | 601-754-5400
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 962
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City | FAYETTE
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State | MS
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Zip | 39069-0962
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Country | US
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Telephone | 601-754-5400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEIQUANAE TATAYANA SMITH
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Credential |
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Telephone | 601-754-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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