Provider Demographics
NPI:1487639548
Name:HOME HEALTH CARE SERVICES II, INC.
Entity Type:Organization
Organization Name:HOME HEALTH CARE SERVICES II, INC.
Other - Org Name:ADORATION HOME HEALTH CARE MISSISSIPPI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:S
Authorized Official - Last Name:PEMBERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-394-2321
Mailing Address - Street 1:805 N WHITTINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-7101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:803 E SUNFLOWER RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2823
Practice Address - Country:US
Practice Address - Phone:662-846-7693
Practice Address - Fax:662-843-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2024-01-11
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-07-25
Provider Licenses
StateLicense IDTaxonomies
MS3794251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000770560Medicaid
MS0770560Medicaid
MS000070067OtherBCBS PROVIDER #
MS000070067OtherBCBS PROVIDER #
MS25Q7305005Medicare ID - Type UnspecifiedCHARLESTON BRANCH ID
MS25Q7305001Medicare ID - Type UnspecifiedCLARKSDALE BRANCH ID #
MS25Q7305004Medicare ID - Type UnspecifiedMARKS BRANCH ID
MS25-7305Medicare PIN