Provider Demographics
NPI:1952188963
Name:LS PRIVATE HOMECARE SERVICE
Entity Type:Organization
Organization Name:LS PRIVATE HOMECARE SERVICE
Other - Org Name:HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAREGIVER
Authorized Official - Prefix:
Authorized Official - First Name:LAQUITA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-575-0583
Mailing Address - Street 1:114 FOLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-6613
Mailing Address - Country:US
Mailing Address - Phone:601-575-0583
Mailing Address - Fax:
Practice Address - Street 1:114 FOLEY AVE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-6613
Practice Address - Country:US
Practice Address - Phone:601-575-0583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty
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, ChildGroup - Single Specialty