Basic Information
| Provider Information | |||||||||
| NPI: | 1184924318 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOSPICE PROVIDERS, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HOSPICE IN HIS HANDS - MAGEE DIVISION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13 NORTHTOWN DR | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392113047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019568276 | ||||||||
| FaxNumber: | 6017090832 | ||||||||
| Practice Location | |||||||||
| Address1: | 402 5TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | MAGEE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391113950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018495903 | ||||||||
| FaxNumber: | 6018495346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2010 | ||||||||
| LastUpdateDate: | 10/21/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SHELTON | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 6019568276 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 315D00000X | 140 | MS | Y | Nursing & Custodial Care Facilities | Hospice, Inpatient |
ID Information
| ID | Type | State | Issuer | Description | 08877861 | 05 | MS | MEDICAID |