Provider Demographics
NPI:1255186615
Name:VITACARE HEALTH LLC
Entity type:Organization
Organization Name:VITACARE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEQUESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:POWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-543-2040
Mailing Address - Street 1:502 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-5019
Mailing Address - Country:US
Mailing Address - Phone:800-527-6811
Mailing Address - Fax:800-527-6811
Practice Address - Street 1:502 8TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-5019
Practice Address - Country:US
Practice Address - Phone:800-527-6811
Practice Address - Fax:800-527-6811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No385H00000XRespite Care FacilityRespite Care