Healthcare Provider Details

I. General information

NPI: 1164893343
Provider Name (Legal Business Name): HOMECARE HOSPICE NORTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 STATE HIGHWAY 30 W STE B
NEW ALBANY MS
38652-2402
US

IV. Provider business mailing address

PO BOX 2130
DAPHNE AL
36526-2130
US

V. Phone/Fax

Practice location:
  • Phone: 662-539-7339
  • Fax: 662-539-7324
Mailing address:
  • Phone: 205-652-6167
  • Fax: 205-742-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LEWIS CLARK BLAIR
Title or Position: CEO
Credential:
Phone: 205-652-6167