MEDICARE: MORIAH HOSPICE AND PALLIATIVE CARE,LLC,INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1316166739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORIAH HOSPICE AND PALLIATIVE CARE,LLC,INC.

Provider Business Mailing Address
First Line	:	904 SOUTH STREET
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-3528
Country	:	US
Telephone Number	:	662-843-8766
Fax Number	:

Provider Business Practice Location Address
First Line	:	904 SOUTH ST
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-3528
Country	:	US
Telephone Number	:	662-843-8766
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LORENZO ANDERSON
Credential	:
Telephone Number	:	662-843-8766

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/22/2020

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