Basic Information
| Provider Information | |||||||||
| NPI: | 1710922380 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEART TO HEART HOSPICE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115A HIGHWAY 12 W | ||||||||
| Address2: | |||||||||
| City: | STARKVILLE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 397593761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6626151519 | ||||||||
| FaxNumber: | 6626151554 | ||||||||
| Practice Location | |||||||||
| Address1: | 115A HIGHWAY 12 W | ||||||||
| Address2: | |||||||||
| City: | STARKVILLE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 397593761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6626151519 | ||||||||
| FaxNumber: | 6626151554 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 06/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | HICKS | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9018546185 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 105 | MS | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 00770496 | 05 | MS | MEDICAID |