| Organization Name: | CAMELLIA HOSPICE OF NORTHEAST MISSISSIPPI, LLC |
| NPI Number: | 1265710404 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WILFORD A PAYNE (PRESIDENT / OWNER) |
| Mailing Address: | 499 Gloster Creek Vlg Ste I7 Tupelo |
| State: | MS US |
| Postal Code: | 388014709 |
| Phone Number: | 6628442870 |
| Fax Number: | 6628442871 |
| NPI Enumeration Date: | 07/21/2011 |
| NPI Last Update Date: | 09/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |