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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