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General NPI Number Information
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NPI Number | 1598539975
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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 | 11/07/2023
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 359 TOWNE CENTER BLVD STE 500
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City | RIDGELAND
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State | MS
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Zip | 39157-4862
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Country | US
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Telephone | 601-991-3840
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Fax |
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Provider Business Mailing Address
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Address Line | 359 TOWNE CENTER BLVD STE 500
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City | RIDGELAND
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State | MS
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Zip | 39157-4862
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Country | US
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Telephone | 601-991-3840
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Fax |
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Authorized Official
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Title or Position | PRESIDENT ASI MANAGEMENT
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Name | TONI H. 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 |
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License Number State |
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