Provider Demographics
NPI:1538696059
Name:NORTH YALOBUSHA HOSPICE & PALLIATIVE CARE, INC.
Entity Type:Organization
Organization Name:NORTH YALOBUSHA HOSPICE & PALLIATIVE CARE, INC.
Other - Org Name:NORTH YALOBUSHA HOSPICE & PALLIATIVE CARE, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:LEMANS
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:662-887-1146
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MS
Mailing Address - Zip Code:38948-0156
Mailing Address - Country:US
Mailing Address - Phone:662-623-0946
Mailing Address - Fax:
Practice Address - Street 1:128 MAIN ST
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:MS
Practice Address - Zip Code:38751-2843
Practice Address - Country:US
Practice Address - Phone:662-887-1268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-15
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2080H0002X
251C00000X, 251E00000X, 251G00000X, 251J00000X, 251X00000X, 253Z00000X, 261QA0600X, 342000000X, 343800000X, 343900000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative MedicineGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No251X00000XAgenciesSupports Brokerage
No253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No342000000XTransportation ServicesTransportation Network Company
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00938864Medicaid