1376863209 NPI number — NORTH HAVEN HOSPICE & PALLIATIVE CARE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376863209 NPI number — NORTH HAVEN HOSPICE & PALLIATIVE CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH HAVEN HOSPICE & PALLIATIVE CARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376863209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
POB 537
Provider Second Line Business Mailing Address:
1696 SOUTH COLORADO, SUTE 4
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38701-7216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-822-5844
Provider Business Mailing Address Fax Number:
662-335-1789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1696 SOUTH COLRADO STREET
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38701-7216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-822-5844
Provider Business Practice Location Address Fax Number:
662-335-1789
Provider Enumeration Date:
06/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BRANDON
Authorized Official First Name:
WENDELL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
662-822-5844

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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