1902105976 NPI number — MERCY HOSPICE LLC

Table of content: (NPI 1902105976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902105976 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:
Provider Other Organization Name Type Code:
6
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:
1902105976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2025
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:
206-652-6167
Provider Business Mailing Address Fax Number:
205-652-9110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 STARK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STARKVILLE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39759-3556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-338-0007
Provider Business Practice Location Address Fax Number:
662-338-0025
Provider Enumeration Date:
03/16/2011

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  151 , 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: 05677023 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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