1386689016 NPI number — MERCY HOSPICE LLC

Table of content: (NPI 1386689016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386689016 NPI number — MERCY HOSPICE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY HOSPICE 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:
LEGACY HOSPICE OF THE SOUTH
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:
1386689016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAPHNE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36526-2130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-686-0138
Provider Business Mailing Address Fax Number:
205-742-0028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 EAST JEFFERSON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIPLEY
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-837-9990
Provider Business Practice Location Address Fax Number:
662-837-6969
Provider Enumeration Date:
06/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SANDERS
Authorized Official First Name:
KATIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF SYSTEMS AND CONTROL
Authorized Official Telephone Number:
334-686-0138

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  053 , 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: 0251552 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00770300 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".