Provider Demographics
NPI:1568785475
Name:HEALING TOUCH HOMEMAKER AND COMPANION AGENCY
Entity Type:Organization
Organization Name:HEALING TOUCH HOMEMAKER AND COMPANION AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MIKELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-236-6453
Mailing Address - Street 1:20144 PINEVILLE ROAD
Mailing Address - Street 2:B
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560
Mailing Address - Country:US
Mailing Address - Phone:228-236-6453
Mailing Address - Fax:228-863-6007
Practice Address - Street 1:2318 PASS RD STE 7B
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4044
Practice Address - Country:US
Practice Address - Phone:228-388-7148
Practice Address - Fax:228-388-7150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251J00000X
MS376J00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02571562Medicaid
MS03653262Medicaid