=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629018106
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEVERLY HOSPICE MINISTRIES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6531 DOGWOOD VIEW PKWY SUITE A
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39213-7827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-713-0061
-----------------------------------------------------
Fax | 601-713-4247
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9303
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39286-9303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-713-0061
-----------------------------------------------------
Fax | 601-713-4247
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. BEVERLY FARABEE
-----------------------------------------------------
Credential | RN, BSN
-----------------------------------------------------
Telephone | 601-713-0061
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | 056
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------