MEDICARE: ST. JOSEPH HOSPICE OF WEST MISSISSIPPI, LLC

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	083	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	:	1710980222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JOSEPH HOSPICE OF WEST MISSISSIPPI, LLC

Provider Business Mailing Address
First Line	:	10615 JEFFERSON HWY
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-7230
Country	:	US
Telephone Number	:	225-368-3181
Fax Number	:	225-757-1104

Provider Business Practice Location Address
First Line	:	120 SCARBROUGH ST STE C
Second Line	:
City	:	RICHLAND
State	:	MS
Zip	:	39218-9798
Country	:	US
Telephone Number	:	601-925-0418
Fax Number	:	601-924-9975

Authorized Official
Title or Position	:	CEO
Name	:	PATRICK MITCHELL
Credential	:
Telephone Number	:	225-368-3181

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	04/25/2024

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