Lilly Pad Home Health, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

LILLY PAD HOME HEALTH, LLC

Practice address

1507 Hardy St Ste 201
Hattiesburg, MS 39401-4978

Phone

(601) 410-5836

Fax

(888) 449-9560

NPI assigned

Dec 4, 2017

Last updated

Nov 6, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Latonya HailesNPI 1487800710

Title

Ceo/Administrator

Phone

(601) 336-6114

Specialties & licenses 5

Addresses

Other names 1

• Lilly Pad Home Health, LLC Former legal business name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Tax ID family

Lilly Pad Home Health LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Lilly Pad Home Health

  • Community/Behavioral Health Agency
  • Mobile, AL
  • NPI 1255846994
  NPD tax ID
• Lilly Pad Home Health, LLC

  • Home Health Agency
  • Mobile, AL
  • NPI 1942715289
  NPD tax ID

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shuntay McCormick

  • Family Nurse Practitioner
  • Hattiesburg, MS
  • NPI 1467931642
  Medicare reassignment NPD
• Carla Lee Rawls, LPC, NCC, NCSC

  • Professional Counselor
  • Hattiesburg, MS
  • NPI 1568036150
  Medicare reassignment NPD
• Latonya Hailes

  • Community Health Worker
  • Hattiesburg, MS
  • NPI 1487800710
  Authorized official Same address or phone

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

{
    "created_epoch": "1512345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572998400000",
    "number": "1396250031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1507 HARDY ST STE 201",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394014978",
            "telephone_number": "601-410-5836",
            "fax_number": "888-449-9560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1507 HARDY ST STE 201",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394014978",
            "telephone_number": "601-410-5836",
            "fax_number": "888-449-9560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LILLY PAD HOME HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-04",
        "last_updated": "2019-11-06",
        "status": "A",
        "authorized_official_last_name": "HAILES",
        "authorized_official_first_name": "LATONYA",
        "authorized_official_title_or_position": "CEO/ADMINISTRATOR",
        "authorized_official_telephone_number": "601-336-6114"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Homemaker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Hattiesburg",
            "affiliation": "N",
            "endpointDescription": "Administrative Office",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1507 Hardy St Ste 201",
            "city": "Hattiesburg",
            "state": "MS",
            "country_code": "US",
            "postal_code": "394014978",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Lilly Pad Home Health, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Timothy Lewis, CRNA
• Hal T Liddell, M.D.
• Thompson Worth Liddell, M.D.
• Lifecycle Nutrition Services LLC (Lifecycle Nutrition)
• Lilly Pad Home Health, LLC
• Andrew C Lin, MD
• Lincare Inc.
• Lincoln Center Clinic
• Lincoln Dental Arts, PLLC
• Charles Palmer Lincoln, MD

• Community/Behavioral Health Agency in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Community/Behavioral Health Agency in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.