Provider Demographics
NPI:1013534650
Name:RANDOLPH'S DEVOTED HOME CARE
Entity Type:Organization
Organization Name:RANDOLPH'S DEVOTED HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BIANCA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-755-5066
Mailing Address - Street 1:6901 HIGHWAY 305 N STE F
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-2317
Mailing Address - Country:US
Mailing Address - Phone:662-755-5066
Mailing Address - Fax:
Practice Address - Street 1:6901 HIGHWAY 305 N STE F
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-2317
Practice Address - Country:US
Practice Address - Phone:901-347-7221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-30
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care