Organization
FIT JAM LLC
Active
Other names
Visiting Angels
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY LEE EVANS (OWNER)
(662) 836-6528
Entity
Organization
Contact information
Practice address
509 S MAIN ST STE 20, PETAL, MS 39465-2203
(601) 336-4144
Mailing address
509 S MAIN ST STE 20, PETAL, MS 39465-2203
(601) 336-4144
(601) 582-7697
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
385H00000X
Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06804375
—
MS
Enumeration date
07/29/2022
Last updated
07/29/2022
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