Healthcare Provider Details

I. General information

NPI: 1508804956
Provider Name (Legal Business Name): ASERACARE HOSPICE - GULFPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MARKS RD
OCEAN SPRINGS MS
39564-4351
US

IV. Provider business mailing address

21 MARKS RD
OCEAN SPRINGS MS
39564-4351
US

V. Phone/Fax

Practice location:
  • Phone: 901-758-1450
  • Fax:
Mailing address:
  • Phone: 901-758-1450
  • Fax:

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: HOLLY A RASMUSSEN-JONES
Title or Position: ASST SECRETARY
Credential:
Phone: 479-201-4840