Provider Demographics
NPI:1518536333
Name:LANDAS HEALTHCARE SERVICE
Entity Type:Organization
Organization Name:LANDAS HEALTHCARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YALANDA
Authorized Official - Middle Name:DENICKE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-325-7621
Mailing Address - Street 1:30 EVERGREEN PL
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-9439
Mailing Address - Country:US
Mailing Address - Phone:601-325-7621
Mailing Address - Fax:
Practice Address - Street 1:30 EVERGREEN PL
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465-9439
Practice Address - Country:US
Practice Address - Phone:601-325-7621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANDAS HEALTHCARE SERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-24
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health