Healthcare Provider Details

I. General information

NPI: 1518256460
Provider Name (Legal Business Name): MERCY HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 WOODED DRIVE
GRENADA MS
38901
US

IV. Provider business mailing address

PO BOX 2130
DAPHNE AL
36526-2130
US

V. Phone/Fax

Practice location:
  • Phone: 662-226-4246
  • Fax: 662-226-1097
Mailing address:
  • Phone: 334-686-0138
  • Fax: 205-652-9110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number92
License Number StateMS

VIII. Authorized Official

Name: LEWIS C BLAIR
Title or Position: CEO
Credential:
Phone: 205-652-6167