Provider Demographics
NPI:1518267442
Name:HOSPICE PROVIDERS, LLC
Entity Type:Organization
Organization Name:HOSPICE PROVIDERS, LLC
Other - Org Name:HOSPICE IN HIS HANDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-956-8276
Mailing Address - Street 1:13 NORTHTOWN DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-3047
Mailing Address - Country:US
Mailing Address - Phone:601-956-8276
Mailing Address - Fax:601-709-0832
Practice Address - Street 1:242 THAGGARD RD
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-9517
Practice Address - Country:US
Practice Address - Phone:601-267-6830
Practice Address - Fax:601-267-6690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS067315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0770517Medicaid
MS0770517Medicaid