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General NPI Number Information
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NPI Number | 1417915091
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Entity Type | Organization
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Legal Business Name | LIFE SOURCE SERVICES, LLC
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 01/14/2021
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Provider Practice Location Address
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Address Line | 129 EXECUTIVE DR SUITE C
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City | MADISON
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State | MS
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Zip | 39110-8473
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Country | US
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Telephone | 601-898-1510
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Fax | 601-898-1560
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Provider Business Mailing Address
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Address Line | 129 EXECUTIVE DR SUITE C
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City | MADISON
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State | MS
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Zip | 39110-8473
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Country | US
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Telephone | 601-898-1510
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Fax | 601-898-1560
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Authorized Official
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Title or Position | AUTHORIZED REPRESENTATIVE
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Name | MS. TONI PARKINSON
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Credential |
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Telephone | 601-709-1408
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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 | 079
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License Number State | LA
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