Provider Demographics
NPI:1548581499
Name:PERENNIAL HOSPICE, INC.
Entity Type:Organization
Organization Name:PERENNIAL HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-717-2711
Mailing Address - Street 1:5201 CEDAR PARK DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-4140
Mailing Address - Country:US
Mailing Address - Phone:601-366-8995
Mailing Address - Fax:
Practice Address - Street 1:5201 CEDAR PARK DR
Practice Address - Street 2:SUITE D
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4140
Practice Address - Country:US
Practice Address - Phone:601-366-8995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based