Healthcare Provider Details

I. General information

NPI: 1801812185
Provider Name (Legal Business Name): HOSPICE CARE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E DONALD ST
QUITMAN MS
39355-2025
US

IV. Provider business mailing address

114 E DONALD ST
QUITMAN MS
39355-2025
US

V. Phone/Fax

Practice location:
  • Phone: 601-776-8880
  • Fax: 601-776-8881
Mailing address:
  • Phone: 601-776-8880
  • Fax: 601-776-8881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. THERESA LYNN ZDENEK
Title or Position: ADMINISTRATOR
Credential: LPN
Phone: 601-776-8880