Provider Demographics
NPI:1164893343
Name:HOMECARE HOSPICE NORTH, LLC
Entity Type:Organization
Organization Name:HOMECARE HOSPICE NORTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-652-6167
Mailing Address - Street 1:301 STATE HIGHWAY 30 W STE B
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-2402
Mailing Address - Country:US
Mailing Address - Phone:662-539-7339
Mailing Address - Fax:662-539-7324
Practice Address - Street 1:301 STATE HIGHWAY 30 W STE B
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-2402
Practice Address - Country:US
Practice Address - Phone:662-539-7339
Practice Address - Fax:662-539-7324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based