# MOSSY OAK PERSONAL CARE HOME LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053287698
- **Authorized official:** KATIE HIRES (OWNER)
- **Authorized official phone:** (912) 294-2837

## Contact information

- **Practice address:** 1150 RIVER RD, JESUP, GA 31546-1303
- **Practice address phone:** (912) 588-0065
- **Mailing address:** 1150 RIVER RD, JESUP, GA 31546-1303
- **Mailing address phone:** (912) 588-0065

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 10/13/2025
- **Last updated:** 10/13/2025