1598853509 NPI number — DELTA AREA HOSPICE CARE LIMITED

Table of content: (NPI 1598853509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598853509 NPI number — DELTA AREA HOSPICE CARE LIMITED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELTA AREA HOSPICE CARE LIMITED
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:
1598853509
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5915
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38704-5915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-335-7040
Provider Business Mailing Address Fax Number:
662-335-7027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
522 ARNOLD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38701-5319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-335-7040
Provider Business Practice Location Address Fax Number:
662-335-7027
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BLAKELY
Authorized Official First Name:
HAROLD
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
662-335-7040

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  012 , 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: 00770012 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 251514 . This is a "MEDICARE HOSPICE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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