Provider Demographics
NPI:1922494541
Name:TRADITION HOME CARE LLC
Entity Type:Organization
Organization Name:TRADITION HOME CARE LLC
Other - Org Name:TRADITION HOME CARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-583-9401
Mailing Address - Street 1:713 RONIE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-4345
Mailing Address - Country:US
Mailing Address - Phone:601-583-9401
Mailing Address - Fax:
Practice Address - Street 1:713 RONIE ST
Practice Address - Street 2:SUITE C
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-4345
Practice Address - Country:US
Practice Address - Phone:601-583-9401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care