Provider Demographics
NPI:1114619756
Name:HEROIC HOME HEALTH
Entity Type:Organization
Organization Name:HEROIC HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:INDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:176-934-8817
Mailing Address - Street 1:770 LAKELAND DR APT 137
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4636
Mailing Address - Country:US
Mailing Address - Phone:769-348-8174
Mailing Address - Fax:
Practice Address - Street 1:770 LAKELAND DR APT 137
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4636
Practice Address - Country:US
Practice Address - Phone:769-348-8174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health