Healthcare Provider Details

I. General information

NPI: 1518219773
Provider Name (Legal Business Name): HOMECARE HOSPICE SOUTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2903 ARLINGTON LOOP
HATTIESBURG MS
39401-7115
US

IV. Provider business mailing address

PO BOX 2130
DAPHNE AL
36526-2130
US

V. Phone/Fax

Practice location:
  • Phone: 601-906-6105
  • Fax: 601-602-2847
Mailing address:
  • Phone: 205-652-6167
  • Fax: 205-742-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. LEWIS CLARK BLAIR
Title or Position: CEO
Credential:
Phone: 205-652-6167