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General NPI Number Information
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NPI Number | 1184411654
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Entity Type | Organization
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Legal Business Name | ARDEN OF NORTHEAST MISSISSIPPI, LLC
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 1022 COMMONWEALTH BLVD
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City | TUPELO
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State | MS
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Zip | 38804-9300
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Country | US
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Telephone | 662-269-8959
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Fax | 662-269-8969
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Provider Business Mailing Address
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Address Line | 133 MAYFAIR RD
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City | HATTIESBURG
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State | MS
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Zip | 39402-1464
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Country | US
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Telephone | 601-582-6031
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | WILFORD A PAYNE III
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Credential |
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Telephone | 601-582-6031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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