Provider Demographics
NPI:1104456979
Name:CAREFREE LIVING AT HOME LLC
Entity type:Organization
Organization Name:CAREFREE LIVING AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:601-618-3099
Mailing Address - Street 1:460 BRIARWOOD DR STE 400-1010
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-3051
Mailing Address - Country:US
Mailing Address - Phone:601-618-3099
Mailing Address - Fax:
Practice Address - Street 1:460 BRIARWOOD DR STE 400-1010
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-3051
Practice Address - Country:US
Practice Address - Phone:601-301-9400
Practice Address - Fax:601-368-8904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS623312OtherASSISTED LIVING FACILITIES FOR THE ELDERLY