Healthcare Provider Details

I. General information

NPI: 1831302520
Provider Name (Legal Business Name): HOMETOWN HOSPICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8366 HIGHWAY 19 N
COLLINSVILLE MS
39325-9395
US

IV. Provider business mailing address

8366 HIGHWAY 19 N
COLLINSVILLE MS
39325-9395
US

V. Phone/Fax

Practice location:
  • Phone: 601-626-7277
  • Fax: 601-626-8988
Mailing address:
  • Phone: 601-626-7277
  • Fax: 601-626-8988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number046
License Number StateMS

VIII. Authorized Official

Name: MR. JOHN ARVLE KINGERY
Title or Position: PRESIDENT CEO
Credential:
Phone: 601-626-7277