MEDICARE: NEW COVENANT HOSPICE, 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

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	:	1801955356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW COVENANT HOSPICE, LLC

Provider Business Mailing Address
First Line	:	804 1ST ST
Second Line	:	SUITE 1
City	:	CLEVELAND
State	:	MS
Zip	:	38732-2310
Country	:	US
Telephone Number	:	662-843-3395
Fax Number	:	662-843-3903

Provider Business Practice Location Address
First Line	:	804 1ST ST
Second Line	:	SUITE 1
City	:	CLEVELAND
State	:	MS
Zip	:	38732-2310
Country	:	US
Telephone Number	:	662-843-3395
Fax Number	:	662-843-3903

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. RICHARD KEYES
Credential	:
Telephone Number	:	662-843-3395

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	12/18/2007

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