Provider Demographics
NPI:1447649009
Name:PRAETORIAN HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:PRAETORIAN HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAYARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-596-5719
Mailing Address - Street 1:PO BOX 7066
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39506-7066
Mailing Address - Country:US
Mailing Address - Phone:228-314-1290
Mailing Address - Fax:
Practice Address - Street 1:10241 BONEY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-4889
Practice Address - Country:US
Practice Address - Phone:228-314-1290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care