Healthcare Provider Details

I. General information

NPI: 1942731914
Provider Name (Legal Business Name): HEART OF HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 LAKELAND DR STE 407
JACKSON MS
39216-4845
US

IV. Provider business mailing address

PO BOX 51266
LAFAYETTE LA
70505-1266
US

V. Phone/Fax

Practice location:
  • Phone: 662-350-0830
  • Fax: 769-208-4512
Mailing address:
  • Phone: 337-233-1307
  • Fax: 337-443-4154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number196
License Number StateMS

VIII. Authorized Official

Name: JOSHUA L PROFFITT
Title or Position: PRESIDENT
Credential:
Phone: 337-233-1307