Provider Demographics
NPI:1164593158
Name:GENESIS HOSPICE CARE
Entity Type:Organization
Organization Name:GENESIS HOSPICE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:662-846-0100
Mailing Address - Street 1:PO BOX 1888
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-1888
Mailing Address - Country:US
Mailing Address - Phone:662-846-0100
Mailing Address - Fax:662-846-0833
Practice Address - Street 1:201 HIGHWAY 82 W
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:MS
Practice Address - Zip Code:38751-2141
Practice Address - Country:US
Practice Address - Phone:662-887-1274
Practice Address - Fax:662-887-7263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03485082Medicaid
MS03485082Medicaid