Martha's Care Pca Agency

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

License

253Z00000X Issued in MS

Legal business name

MARTHA'S CARE PCA AGENCY

Practice address

791 Goodhope Road
Bassfield, MS 39421

Phone

(601) 543-9482

NPI assigned

Oct 31, 2011

Last updated

Oct 31, 2011By 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

Ms. Gwendolyn Booth

Title

Co-Owner

Phone

60154394882

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1320019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320019200000",
    "number": "1871879213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "791 GOODHOPE ROAD",
            "city": "BASSFIELD",
            "state": "MS",
            "postal_code": "39421",
            "telephone_number": "601-543-9482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "791 GOODHOPE ROAD",
            "city": "BASSFIELD",
            "state": "MS",
            "postal_code": "39421",
            "telephone_number": "601-543-9482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTHA'S CARE PCA AGENCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-31",
        "last_updated": "2011-10-31",
        "status": "A",
        "authorized_official_last_name": "BOOTH",
        "authorized_official_first_name": "GWENDOLYN",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "60154394882",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "MS",
            "license": "253Z00000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• In Home Supportive Care Agency in Bassfield, MS
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2011; 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.