Provider Demographics
NPI:1215223680
Name:PALLIATIVE HEALTHCARE
Entity Type:Organization
Organization Name:PALLIATIVE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAMEIKA
Authorized Official - Middle Name:BRIDGES
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-624-3876
Mailing Address - Street 1:510 NORTHPOINTE PKWY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-2301
Mailing Address - Country:US
Mailing Address - Phone:601-624-3876
Mailing Address - Fax:
Practice Address - Street 1:510 NORTHPOINTE PKWY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-2301
Practice Address - Country:US
Practice Address - Phone:601-624-3876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health