Provider Demographics
NPI:1386267912
Name:HERSEE HEALTHCARE FOR CHILDREN, LLC
Entity type:Organization
Organization Name:HERSEE HEALTHCARE FOR CHILDREN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN. OPERATIONS CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-519-8960
Mailing Address - Street 1:PO BOX 893
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39043-0893
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1618 MAIN ST
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-2840
Practice Address - Country:US
Practice Address - Phone:601-519-8960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care