Healthcare Provider Details

I. General information

NPI: 1275631699
Provider Name (Legal Business Name): MISSISSIPPI HOLISTIC HOSPICE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 EAST STREET UNIT A
LELAND MS
38756
US

IV. Provider business mailing address

POST OFFICE BOX 436
STONEVILLE MS
38776
US

V. Phone/Fax

Practice location:
  • Phone: 662-686-9000
  • Fax: 662-686-9900
Mailing address:
  • Phone: 662-686-9000
  • Fax: 662-686-9900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number00923355
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number251600
License Number StateMS

VIII. Authorized Official

Name: MRS. GERALDINE CHERRY
Title or Position: ADMINISTRATOR
Credential: RNC
Phone: 662-843-5454