Provider Demographics
NPI:1205845989
Name:HERITAGE HOSPICE, INC
Entity Type:Organization
Organization Name:HERITAGE HOSPICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-286-5333
Mailing Address - Street 1:301 E WALDRON ST
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-4756
Mailing Address - Country:US
Mailing Address - Phone:662-286-5333
Mailing Address - Fax:662-286-0052
Practice Address - Street 1:301 E WALDRON ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-4756
Practice Address - Country:US
Practice Address - Phone:662-286-5333
Practice Address - Fax:662-286-0052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS070251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770562Medicaid
MS00770562Medicaid