Provider Demographics
NPI:1083116685
Name:LEAN ON ME, LLC
Entity Type:Organization
Organization Name:LEAN ON ME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME HEALTH CARE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-207-8066
Mailing Address - Street 1:PO BOX 1073
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:MS
Mailing Address - Zip Code:38751-1073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 HIGHWAY 82 E
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:MS
Practice Address - Zip Code:38751-2317
Practice Address - Country:US
Practice Address - Phone:662-207-8066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS=========Medicaid