Provider Demographics
NPI:1568732105
Name:DOVES HOME CARE
Entity Type:Organization
Organization Name:DOVES HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TRASK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-336-6220
Mailing Address - Street 1:1520 ADELINE ST
Mailing Address - Street 2:H
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-6265
Mailing Address - Country:US
Mailing Address - Phone:601-336-6220
Mailing Address - Fax:
Practice Address - Street 1:1520 ADELINE ST
Practice Address - Street 2:H
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-6265
Practice Address - Country:US
Practice Address - Phone:601-336-6220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS376J00000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02775009Medicaid