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Organization
PRIVATE HOME AND PERSONAL CARE SERVICE
Active
Organization
PRIVATE HOME AND PERSONAL CARE SERVICE
Active
Other names
Lisa Ann Fortt
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA ANN FORTT (OWNER)
(662) 328-9862
Entity
Organization
Contact information
Practice address
53 FULGHAM DR, COLUMBUS, MS 39705-2829
(662) 904-1066
(662) 328-9862
Mailing address
53 FULGHAM DR, P.O. BOX 8553, COLUMBUS, MS 39705-2829
(662) 904-1066
(662) 328-9862
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00374024
—
MS
05
—
03875729
—
MS
Enumeration date
01/17/2008
Last updated
01/17/2008
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