MEDICARE: PERENNIAL HOSPICE, 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	:	1548581499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERENNIAL HOSPICE, INC.

Provider Business Mailing Address
First Line	:	5201 CEDAR PARK DR
Second Line	:	SUITE D
City	:	JACKSON
State	:	MS
Zip	:	39206-4140
Country	:	US
Telephone Number	:	601-366-8995
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 CEDAR PARK DR
Second Line	:	SUITE D
City	:	JACKSON
State	:	MS
Zip	:	39206-4140
Country	:	US
Telephone Number	:	601-366-8995
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	VERNON RICHARD
Credential	:
Telephone Number	:	601-717-2711

Provider Enumeration Date	:	06/15/2010
Last Update Date	:	06/15/2010

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