Private Home and Personal Care Service

Primary specialty

Respite CareTaxonomy code 385H00000X

Legal business name

PRIVATE HOME AND PERSONAL CARE SERVICE

Practice address

53 Fulgham Dr
Columbus, MS 39705-2829

Phone

(662) 904-1066

Fax

(662) 328-9862

NPI assigned

Jan 17, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Lisa Ann Fortt

Title

Owner

Phone

(662) 328-9862

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Lisa Ann Fortt Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1200528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200528000000",
    "number": "1194901397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53 FULGHAM DR",
            "address_2": "P.O. BOX 8553",
            "city": "COLUMBUS",
            "state": "MS",
            "postal_code": "397052829",
            "telephone_number": "662-904-1066",
            "fax_number": "662-328-9862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 FULGHAM DR",
            "city": "COLUMBUS",
            "state": "MS",
            "postal_code": "397052829",
            "telephone_number": "662-904-1066",
            "fax_number": "662-328-9862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVATE HOME AND PERSONAL CARE SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-17",
        "last_updated": "2008-01-17",
        "status": "A",
        "authorized_official_last_name": "FORTT",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-328-9862",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00374024",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03875729",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lisa Ann Fortt",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jennifer E Pounders, M.S., CCC-SLP
• Shelia Renee Powers
• Prairie Anesthesia, PLLC
• Premier Family Practice, LLC
• Johanna R Price, PHD CCCSLP
• Jermaine Pruitt, MS
• Shaquita Uniece Pruitt, PHARMD
• Psycamore Psychiatric Programs, LLC
• Bryndi Kelson Pugh, OTRL
• Carol McMillen Punday, M.S

• Respite Care in Columbus, MS
• Providers in Columbus, MS by specialty
• Respite Care in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.