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General NPI Number Information
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NPI Number | 1831861053
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Entity Type | Organization
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Legal Business Name | PURITY SERVICES LLC
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 109 EASTHAVEN DR
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City | CLINTON
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State | MS
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Zip | 39056-5319
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Country | US
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Telephone | 601-941-0556
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Fax |
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Provider Business Mailing Address
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Address Line | 123A HIGHWAY 80 E STE 229
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City | CLINTON
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State | MS
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Zip | 39056-4738
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Country | US
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Telephone | 601-941-0556
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MS. YVETTE FORTNER BUTLER
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Credential | PCA
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Telephone | 601-941-0556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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