Provider Demographics
NPI:1487415790
Name:HAPPY AT HOME PERSONAL CARE SERVICES
Entity type:Organization
Organization Name:HAPPY AT HOME PERSONAL CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURRAGE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:601-480-4754
Mailing Address - Street 1:12485 SCHAMBERVILLE LN
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39325-9195
Mailing Address - Country:US
Mailing Address - Phone:601-480-4754
Mailing Address - Fax:
Practice Address - Street 1:16412 HIGHWAY 16 E
Practice Address - Street 2:
Practice Address - City:DE KALB
Practice Address - State:MS
Practice Address - Zip Code:39328-5507
Practice Address - Country:US
Practice Address - Phone:601-480-4754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1528829512Medicaid
MS1639930936Medicaid
MS01172024233145Medicaid