Provider Demographics
NPI:1063090157
Name:UNCONDITIONAL LOVE HOME CARE
Entity type:Organization
Organization Name:UNCONDITIONAL LOVE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TYDESHEAIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:POOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-810-4101
Mailing Address - Street 1:2344 HACKETT LN
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:MS
Mailing Address - Zip Code:39652-9546
Mailing Address - Country:US
Mailing Address - Phone:601-873-0018
Mailing Address - Fax:
Practice Address - Street 1:2344 HACKETT LN
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:MS
Practice Address - Zip Code:39652-9546
Practice Address - Country:US
Practice Address - Phone:601-873-0018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-30
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care