Organization Name: | PROVIDENCE HOSPICE SOUTH, LLC |
NPI Number: | 1508814708 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHELLE E MEEKS (ADMINISTRATOR) |
Mailing Address: | 811 Rebecca Ave Hattiesburg |
State: | MS US |
Postal Code: | 39401 |
Phone Number: | 6017050360 |
Fax Number: | 6017050365 |
NPI Enumeration Date: | 05/04/2006 |
NPI Last Update Date: | 04/04/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251G00000X |
License Number: | 138 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Hospice Care, Community Based |
Taxonomy Specialization: | |
Taxonomy Definition: |