Healthcare Provider Details

I. General information

NPI: 1871648758
Provider Name (Legal Business Name): MIRACLE CARE HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 EDGEWOOD TERRACE DR SUITE B
JACKSON MS
39206-6216
US

IV. Provider business mailing address

330 EDGEWOOD TERRACE DR SUITE B
JACKSON MS
39206-6216
US

V. Phone/Fax

Practice location:
  • Phone: 601-982-1909
  • Fax: 601-982-8177
Mailing address:
  • Phone: 601-982-1909
  • Fax: 601-982-8177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number087
License Number StateMS

VIII. Authorized Official

Name: MR. EDDIE LEE JR.
Title or Position: CEO
Credential:
Phone: 601-982-1909