Provider Demographics
NPI:1043258478
Name:ASERACARE HOSPICE - MERIDIAN, LLC
Entity Type:Organization
Organization Name:ASERACARE HOSPICE - MERIDIAN, LLC
Other - Org Name:ASERACARE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-201-4840
Mailing Address - Street 1:4825 POPLAR SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-2625
Mailing Address - Country:US
Mailing Address - Phone:901-758-1450
Mailing Address - Fax:
Practice Address - Street 1:4825 POPLAR SPRINGS DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-2625
Practice Address - Country:US
Practice Address - Phone:901-758-1450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770085Medicaid
MS00770085Medicaid