Provider Demographics
NPI:1710382619
Name:PATRIOT HOME CARE
Entity Type:Organization
Organization Name:PATRIOT HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAYTORIA
Authorized Official - Middle Name:MARQUITA-KADESHIA
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-896-1644
Mailing Address - Street 1:324 MANGUM AVE
Mailing Address - Street 2:
Mailing Address - City:MENDENHALL
Mailing Address - State:MS
Mailing Address - Zip Code:39114-3015
Mailing Address - Country:US
Mailing Address - Phone:601-675-7100
Mailing Address - Fax:601-675-7007
Practice Address - Street 1:324 MANGUM AVE
Practice Address - Street 2:
Practice Address - City:MENDENHALL
Practice Address - State:MS
Practice Address - Zip Code:39114-3015
Practice Address - Country:US
Practice Address - Phone:601-675-7100
Practice Address - Fax:601-675-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care