Individual ProviderIvory Headspeth MitchellCase Manager/Care CoordinatorOther Service ProvidersPractice Address906 C M Fagan Dr Bldg A, Hammond, LA 70403-6056(985) 956-7370PECOS EnrollmentBased on the most recent information from CMS, provider Ivory Headspeth Mitchell does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 8 days ago.Profile DetailsProvider ID1104311257Provider TypeIndividualFull NameMitchell, Ivory HeadspethCredentialLPNGenderFemaleSole ProprietorYesEnumeration Date6/29/2018Last Updated6/29/2018Contact InformationPractice LocationPractice Address906 C M Fagan Dr Bldg A, Hammond, LA 70403-6056Phone(985) 956-7370Fax(985) 956-7371Mailing LocationMailing Address906 C M Fagan Dr Bldg A, Hammond, LA 70403-6056Phone(985) 956-7370Fax(985) 956-7371Provider TaxonomiesCodeDescriptionLicenseCode171M00000XPrimaryDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted Issuer