1134362106 NPI number — CAMELLIA HOSPICE OF THE GULF COAST, LLC

Table of content: (NPI 1134362106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134362106 NPI number — CAMELLIA HOSPICE OF THE GULF COAST, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMELLIA HOSPICE OF THE GULF COAST, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ENHABIT HOSPICE OF THE GULF COAST
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134362106
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6688 N CENTRAL EXPY STE 1300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75206-3950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-239-6500
Provider Business Mailing Address Fax Number:
214-239-6581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13155 SHRINERS BLVD STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BILOXI
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39532-8745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-374-4434
Provider Business Practice Location Address Fax Number:
228-436-3679
Provider Enumeration Date:
04/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JOLLEY
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
DIANE
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT
Authorized Official Telephone Number:
214-239-6500

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04233255 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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