Healthcare Provider Details

I. General information

NPI: 1851304406
Provider Name (Legal Business Name): CAMELLIA HOSPICE OF CENTRAL MISSISSIPPI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1867 CRANE RIDGE DR STE 200D
JACKSON MS
39216-4910
US

IV. Provider business mailing address

6688 N CENTRAL EXPY STE 1300
DALLAS TX
75206-3950
US

V. Phone/Fax

Practice location:
  • Phone: 601-932-9066
  • Fax: 601-933-0811
Mailing address:
  • Phone: 214-239-6500
  • Fax: 214-239-6581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number131
License Number StateMS

VIII. Authorized Official

Name: LISA M ARBUCKLE
Title or Position: DIRECTOR, LICENSING & ENROLLMENT
Credential:
Phone: 214-239-6500