Organization
LILLY PAD HOME HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATONYA HAILES (OWNER)
(601) 410-5836
Entity
Organization
Contact information
Practice address
11 NORTH WATER STREET, MOBILE, AL 36602
(601) 410-5836
(888) 449-9560
Mailing address
1507 HARDY STREET, SUITE 201, HATTIESBURG, MS 39401
(601) 336-6114
(888) 449-9560
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
385H00000X
Respite Care
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06732371
—
MS
Enumeration date
12/08/2017
Last updated
12/08/2017
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