1326118522 NPI number — HOMECARE HOSPICE, LLC

Table of content: (NPI 1326118522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326118522 NPI number — HOMECARE HOSPICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMECARE 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:
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:
1326118522
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2024
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:
205-652-6167
Provider Business Mailing Address Fax Number:
205-742-0028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13 NORTHTOWN DR STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39211-3047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
769-257-6347
Provider Business Practice Location Address Fax Number:
769-257-6379
Provider Enumeration Date:
11/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BLAIR
Authorized Official First Name:
LEWIS
Authorized Official Middle Name:
CLARK
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
205-652-6167

Provider Taxonomy Codes

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

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

  • Identifier: 070221 . This is a "BCBS OF MS" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 7976082 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".