Healthcare Provider Details

I. General information

NPI: 1760886253
Provider Name (Legal Business Name): CAMELLIA HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 MAYFAIR RD
HATTIESBURG MS
39402-1464
US

IV. Provider business mailing address

135 MAYFAIR RD
HATTIESBURG MS
39402-1464
US

V. Phone/Fax

Practice location:
  • Phone: 601-544-2900
  • Fax: 601-579-6991
Mailing address:
  • Phone: 601-544-2900
  • Fax: 601-579-6991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LEE CAVENY
Title or Position: COO
Credential: MS
Phone: 601-544-2900