Provider Demographics
NPI:1730929084
Name:ARDEN HOME HEALTH OF WEST MISSISSIPPI LLC
Entity type:Organization
Organization Name:ARDEN HOME HEALTH OF WEST MISSISSIPPI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILFORD
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-582-6031
Mailing Address - Street 1:133 MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1464
Mailing Address - Country:US
Mailing Address - Phone:601-582-6031
Mailing Address - Fax:
Practice Address - Street 1:405 N HAYDEN ST
Practice Address - Street 2:
Practice Address - City:BELZONI
Practice Address - State:MS
Practice Address - Zip Code:39038-3639
Practice Address - Country:US
Practice Address - Phone:662-247-1254
Practice Address - Fax:662-247-2806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health