Provider Demographics
NPI:1902360571
Name:RESILIENCE HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:RESILIENCE HOME CARE SERVICES LLC
Other - Org Name:RESILIENCE HOME CARE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-624-0585
Mailing Address - Street 1:308 DEER HOLW
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6468
Mailing Address - Country:US
Mailing Address - Phone:601-624-0585
Mailing Address - Fax:
Practice Address - Street 1:15 NORTHTOWN DR STE C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-3048
Practice Address - Country:US
Practice Address - Phone:601-624-0585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care