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General NPI Number Information
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NPI Number | 1649490525
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Entity Type | Organization
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Legal Business Name | OUR FAMILY HOME HOSPICE
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2570 BAILEY AVE SUITE 10
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City | JACKSON
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State | MS
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Zip | 39213-6905
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Country | US
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Telephone | 601-362-1712
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Fax | 601-362-7726
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Provider Business Mailing Address
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Address Line | PO BOX 1123
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City | JACKSON
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State | MS
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Zip | 39283-1233
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Country | US
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Telephone | 601-362-1712
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Fax | 601-362-7726
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. JACKIE GARNER
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Credential |
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Telephone | 601-362-1712
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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 | 058
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License Number State | MS
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