Provider Demographics
NPI:1063046902
Name:EMBASSY HOME CARE, LLC
Entity type:Organization
Organization Name:EMBASSY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAWANDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KIRKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-790-1260
Mailing Address - Street 1:PO BOX 2209
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39130-2209
Mailing Address - Country:US
Mailing Address - Phone:601-790-1260
Mailing Address - Fax:601-605-7060
Practice Address - Street 1:298 COMMERCE PARK DR STE D
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2237
Practice Address - Country:US
Practice Address - Phone:601-790-1260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-01
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care