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General NPI Number Information
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NPI Number | 1861101958
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Entity Type | Organization
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Legal Business Name | VALLEY LIVING SOLUTIONS LLC
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Dates
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Enumeration Date | 11/17/2022
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 1507 HARDY ST STE 104
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City | HATTIESBURG
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State | MS
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Zip | 39401-4978
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Country | US
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Telephone | 601-255-1626
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Fax |
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Provider Business Mailing Address
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Address Line | 116 BROOKWOOD LN
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City | HATTIESBURG
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State | MS
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Zip | 39401-5763
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Country | US
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Telephone | 601-255-1626
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | QUINN MARIE GORDON
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Credential | BSBA, NASMCPT
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Telephone | 601-506-1953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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