Provider Demographics
NPI:1376863209
Name:NORTH HAVEN HOSPICE & PALLIATIVE CARE, LLC
Entity Type:Organization
Organization Name:NORTH HAVEN HOSPICE & PALLIATIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-822-5844
Mailing Address - Street 1:POB 537
Mailing Address - Street 2:1696 SOUTH COLORADO, SUTE 4
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-7216
Mailing Address - Country:US
Mailing Address - Phone:662-822-5844
Mailing Address - Fax:662-335-1789
Practice Address - Street 1:1696 SOUTH COLRADO STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-7216
Practice Address - Country:US
Practice Address - Phone:662-822-5844
Practice Address - Fax:662-335-1789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based