Provider Demographics
NPI:1114449501
Name:PEDICARE STAFFING AGENCY, LLC
Entity Type:Organization
Organization Name:PEDICARE STAFFING AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:EASLEY
Authorized Official - Last Name:FLANAGIN
Authorized Official - Suffix:
Authorized Official - Credentials:NNP-BC
Authorized Official - Phone:601-214-2673
Mailing Address - Street 1:PO BOX 124
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39043-0124
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18052 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:TERRY
Practice Address - State:MS
Practice Address - Zip Code:39170-8343
Practice Address - Country:US
Practice Address - Phone:601-214-2673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care