Provider Demographics
NPI:1952898322
Name:LILLY PAD HOME HEALTH, LLC
Entity Type:Organization
Organization Name:LILLY PAD HOME HEALTH, LLC
Other - Org Name:DBA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-336-6114
Mailing Address - Street 1:1507 HARDY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-4978
Mailing Address - Country:US
Mailing Address - Phone:601-336-6114
Mailing Address - Fax:888-449-9560
Practice Address - Street 1:1004 ADAMS ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4365
Practice Address - Country:US
Practice Address - Phone:601-342-2461
Practice Address - Fax:888-449-9560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health