Organization Name: | ETERNITY HOSPICE INC |
NPI Number: | 1730125949 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHARLES L FAIRLEY (PRESIDENT) |
Mailing Address: | 417 Highway 82 E Ste 23 Indianola |
State: | MS US |
Postal Code: | 387512315 |
Phone Number: | 6628873380 |
Fax Number: | 6628873739 |
NPI Enumeration Date: | 06/22/2006 |
NPI Last Update Date: | 11/13/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251G00000X |
License Number: | 093 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Hospice Care, Community Based |
Taxonomy Specialization: | |
Taxonomy Definition: |