Organization
COLEMAN CARE GIVERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS SHUNDOBIE TOMEKA COLEMAN LPN (OWNER)
(601) 201-6807
Entity
Organization
Contact information
Practice address
706 HILLMONT DR, JACKSON, MS 39209-6003
(601) 201-6807
Mailing address
706 HILLMONT DR, JACKSON, MS 39209-6003
(601) 201-6807
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
335215
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275939639
—
MS
Enumeration date
10/19/2017
Last updated
06/16/2018
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