| For The Love Of You | |
|
105 E Center St Hernando MS 38632-2211 | |
| (901) 351-0962 | |
| Not Available |
| Full Name | For The Love Of You |
|---|---|
| Speciality | Clinic/Center |
| Location | 105 E Center St, Hernando, Mississippi |
| Authorized Official Name and Position | Collietta Bassett (OWNER/PROVIDER) |
| Authorized Official Contact | 9012404859 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| For The Love Of You 2851 Stage Village Cv Bartlett TN 38134-4683 Ph: (901) 351-0962 | For The Love Of You 105 E Center St Hernando MS 38632-2211 Ph: (901) 351-0962 |
| NPI Number | 1134898703 |
|---|---|
| Provider Enumeration Date | 09/08/2021 |
| Last Update Date | 09/01/2022 |
| Certification Date | 09/01/2022 |
| Medicare PECOS PAC ID | 4082098413 |
|---|---|
| Medicare Enrollment ID | O20230209000173 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134898703 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Collietta C Bassett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063976983 PECOS PAC ID: 7315277084 Enrollment ID: I20190923001913 |
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