Healthcare Provider Details

I. General information

NPI: 1720081409
Provider Name (Legal Business Name): WIREGRASS HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E SPRING ST STE B1
COOKEVILLE TN
38501-4528
US

IV. Provider business mailing address

PO BOX 4060
MOORESVILLE NC
28117-4060
US

V. Phone/Fax

Practice location:
  • Phone: 931-528-5133
  • Fax: 931-372-0249
Mailing address:
  • Phone: 704-664-2876
  • Fax: 704-664-1306

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: MS. JANET COMBS
Title or Position: VP OF LICENSURE
Credential:
Phone: 704-664-2876