Healthcare Provider Details

I. General information

NPI: 1639890957
Provider Name (Legal Business Name): NEVAEH HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S EDWARD AVE. 116 S EDWARD AVE. SUITE B
MOUND BAYOU MS
38762-0010
US

IV. Provider business mailing address

P.O. BOX 10 1165 EDWARD AVE. SUITE B
MOUND BAYOU MS
38762-0010
US

V. Phone/Fax

Practice location:
  • Phone: 662-719-2005
  • Fax: 662-741-2006
Mailing address:
  • Phone: 662-719-2005
  • Fax: 662-741-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MRS. BEVERLY C JOHNSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 662-719-2005