MEDICARE: NORTH YALOBUSHA HOSPICE & PALLIATIVE CARE, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	251X00000X	Supports Brokerage Agency
2	253Z00000X	In Home Supportive Care Agency
3	261QA0600X	Adult Day Care Clinic/Center
4	342000000X	Transportation Network Company
5	343800000X	Secured Medical Transport (VAN)
6	343900000X	Non-emergency Medical Transport (VAN)
7	385H00000X	Respite Care
8	251J00000X	Nursing Care Agency
9	251C00000X	Developmentally Disabled Services Day Training Agency
10	251E00000X	Home Health Agency
11	251G00000X	Community Based Hospice Care Agency
12	2080H0002X	Pediatric Hospice and Palliative Medicine Physician	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538696059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH YALOBUSHA HOSPICE & PALLIATIVE CARE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 156
Second Line	:
City	:	OAKLAND
State	:	MS
Zip	:	38948-0156
Country	:	US
Telephone Number	:	662-623-0946
Fax Number	:

Provider Business Practice Location Address
First Line	:	128 MAIN ST
Second Line	:
City	:	INDIANOLA
State	:	MS
Zip	:	38751-2843
Country	:	US
Telephone Number	:	662-887-1268
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	DR. ADRIAN LEMANS BROWN
Credential	:	PH.D.
Telephone Number	:	662-887-1146

Provider Enumeration Date	:	05/15/2017
Last Update Date	:	09/25/2023

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