Provider Demographics
NPI:1396250031
Name:LILLY PAD HOME HEALTH, LLC
Entity type:Organization
Organization Name:LILLY PAD HOME HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-336-6114
Mailing Address - Street 1:1507 HARDY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-4978
Mailing Address - Country:US
Mailing Address - Phone:601-410-5836
Mailing Address - Fax:888-449-9560
Practice Address - Street 1:1507 HARDY ST STE 201
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-4978
Practice Address - Country:US
Practice Address - Phone:601-410-5836
Practice Address - Fax:888-449-9560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty