Healthcare Provider Details

I. General information

NPI: 1386930113
Provider Name (Legal Business Name): HOSPICE ADVANTAGE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W CHEROKEE ST
BROOKHAVEN MS
39601
US

IV. Provider business mailing address

10 CADILLAC DR STE 400
BRENTWOOD TN
37027-1001
US

V. Phone/Fax

Practice location:
  • Phone: 601-849-5903
  • Fax: 601-849-5346
Mailing address:
  • Phone: 417-841-4834
  • Fax: 866-995-8538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number140
License Number StateMS

VIII. Authorized Official

Name: RUSSELL ADKINS
Title or Position: SVP GENERAL COUNSEL
Credential:
Phone: 615-309-5668