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General NPI Number Information
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NPI Number | 1720081409
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Entity Type | Organization
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Legal Business Name | WIREGRASS HOSPICE, LLC
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 01/17/2023
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Provider Practice Location Address
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Address Line | 750 E SPRING ST STE B1
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City | COOKEVILLE
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State | TN
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Zip | 38501-4528
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Country | US
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Telephone | 931-528-5133
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Fax | 931-372-0249
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Provider Business Mailing Address
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Address Line | PO BOX 4060
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City | MOORESVILLE
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State | NC
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Zip | 28117-4060
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Country | US
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Telephone | 704-664-2876
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Fax | 704-664-1306
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Authorized Official
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Title or Position | VP OF LICENSURE
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Name | MS. JANET COMBS
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Credential |
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Telephone | 704-664-2876
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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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