Basic Information
| Provider Information | |||||||||
| NPI: | 1679195028 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MID-SOUTH HOME CARE SERVICES, LLC | ||||||||
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| OtherOrganizationName: | KINDRED PALLIATIVE CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 655 BRAWLEY SCHOOL RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281179601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046642876 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4776 NEW BROAD ST STE 150 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328146407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077948382 | ||||||||
| FaxNumber: | 9138145923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2020 | ||||||||
| LastUpdateDate: | 03/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | COMBS | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF LICENUSRE | ||||||||
| AuthorizedOfficialTelephone: | 9138142013 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0002X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
No ID Information.