=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821916925
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOVED ONES HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2026
-----------------------------------------------------
Last Update Date | 07/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7095 TULANE RD N APT 102
-----------------------------------------------------
City | HORN LAKE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38637-1574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-614-7583
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 676
-----------------------------------------------------
City | SOUTHAVEN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38671-0007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | KINYETTA PHILLIPS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 901-614-7583
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------