Provider Demographics
NPI:1497708432
Name:COMPLETE HOSPICE & PALLIATIVE CARE
Entity Type:Organization
Organization Name:COMPLETE HOSPICE & PALLIATIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:CCCSLP
Authorized Official - Phone:662-719-9533
Mailing Address - Street 1:3130 MCINGVALE RD
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-8795
Mailing Address - Country:US
Mailing Address - Phone:662-578-8177
Mailing Address - Fax:662-578-8175
Practice Address - Street 1:103 WOODLAND RD
Practice Address - Street 2:SUITE 7C
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-8483
Practice Address - Country:US
Practice Address - Phone:662-578-8177
Practice Address - Fax:662-578-8175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2007-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07388009Medicaid
MS251628Medicare Oscar/Certification