1982945978 NPI number — AT HOME HOSPICE CARE, INC.

Table of content: (NPI 1982945978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982945978 NPI number — AT HOME HOSPICE CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AT HOME HOSPICE CARE, INC.
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:
1982945978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
306 CHURCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT GIBSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39150-2108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-437-3524
Provider Business Mailing Address Fax Number:
601-437-3570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5015 I 55 N
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39206-4306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-362-1701
Provider Business Practice Location Address Fax Number:
601-362-0405
Provider Enumeration Date:
03/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
FELTON
Authorized Official First Name:
DOROTHY
Authorized Official Middle Name:
JEANETTE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
601-437-3524

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  160 , 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: 1437353752 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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