1427394162 NPI number — SOUTHERN HOSPITALITY HOSPICE & PALLIATIVE CARE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427394162 NPI number — SOUTHERN HOSPITALITY HOSPICE & PALLIATIVE CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN HOSPITALITY HOSPICE & PALLIATIVE CARE, 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:
Provider Other Organization Name Type Code:
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:
1427394162
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 157
Provider Second Line Business Mailing Address:
103 SOUTH BLAKE AVE.
Provider Business Mailing Address City Name:
WINSTONVILLE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38781-0157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-850-4668
Provider Business Mailing Address Fax Number:
662-843-9100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 S SHARPE AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38732-3353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-850-4668
Provider Business Practice Location Address Fax Number:
662-843-9100
Provider Enumeration Date:
12/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BORDERS
Authorized Official First Name:
A.
Authorized Official Middle Name:
DELANE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
313-850-4668

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)





Copyright © 2007-2025 www.npivalidator.com