Provider Demographics
NPI:1871204131
Name:ALFREDA CARING FOR LIFE
Entity type:Organization
Organization Name:ALFREDA CARING FOR LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZATION
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORSHEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-255-6664
Mailing Address - Street 1:20011 SIMPSON DR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MS
Mailing Address - Zip Code:39730-8567
Mailing Address - Country:US
Mailing Address - Phone:662-255-6664
Mailing Address - Fax:
Practice Address - Street 1:20011 SIMPSON DR
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MS
Practice Address - Zip Code:39730-8567
Practice Address - Country:US
Practice Address - Phone:662-255-6664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
621610OtherHOME HEALTH CARE SERVICES