Provider Demographics
NPI:1326118522
Name:HOMECARE HOSPICE, LLC
Entity Type:Organization
Organization Name:HOMECARE HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
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:PO BOX 2130
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-2130
Mailing Address - Country:US
Mailing Address - Phone:205-652-6167
Mailing Address - Fax:205-742-0028
Practice Address - Street 1:13 NORTHTOWN DR STE 130
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-3047
Practice Address - Country:US
Practice Address - Phone:769-257-6347
Practice Address - Fax:769-257-6379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community BasedGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS070221OtherBCBS OF MS
MS7976082Medicaid
MS7976082Medicaid