Provider Demographics
NPI:1275631699
Name:MISSISSIPPI HOLISTIC HOSPICE CARE INC
Entity Type:Organization
Organization Name:MISSISSIPPI HOLISTIC HOSPICE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:RNC
Authorized Official - Phone:662-843-5454
Mailing Address - Street 1:POST OFFICE BOX 436
Mailing Address - Street 2:
Mailing Address - City:STONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38776
Mailing Address - Country:US
Mailing Address - Phone:662-686-9000
Mailing Address - Fax:662-686-9900
Practice Address - Street 1:109 EAST STREET
Practice Address - Street 2:UNIT A
Practice Address - City:LELAND
Practice Address - State:MS
Practice Address - Zip Code:38756
Practice Address - Country:US
Practice Address - Phone:662-686-9000
Practice Address - Fax:662-686-9900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS251600251G00000X
MS00923355251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS251600Medicare Oscar/Certification