Healthcare Provider Details

I. General information

NPI: 1962460568
Provider Name (Legal Business Name): NORTH DELTA HOSPICE AND PALLIATIVE SERVICES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 GOODMAN RD E
SOUTHAVEN MS
38671-9526
US

IV. Provider business mailing address

PO BOX 1798
SOUTHAVEN MS
38671-0019
US

V. Phone/Fax

Practice location:
  • Phone: 662-393-0170
  • Fax: 662-393-0171
Mailing address:
  • Phone: 662-393-0170
  • Fax: 662-393-0171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number137
License Number StateMS

VIII. Authorized Official

Name: RAYMOND E VALLIER
Title or Position: ADMINISTRATOR/OWNER
Credential:
Phone: 901-490-5999