Provider Demographics
NPI:1437833878
Name:ARDEN OF NORTH MISSISSIPPI, LLC
Entity Type:Organization
Organization Name:ARDEN OF NORTH MISSISSIPPI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILFORD
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:601-582-6031
Mailing Address - Street 1:135 MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1464
Mailing Address - Country:US
Mailing Address - Phone:601-582-6031
Mailing Address - Fax:
Practice Address - Street 1:9035 E SANDIDGE RD STE 102
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-3563
Practice Address - Country:US
Practice Address - Phone:662-893-5662
Practice Address - Fax:662-893-5664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based