Provider Demographics
NPI:1588640890
Name:HOSPICE OF THE SOUTH HOLDINGS, LLC
Entity type:Organization
Organization Name:HOSPICE OF THE SOUTH HOLDINGS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-331-6271
Mailing Address - Street 1:1234 CHESTNUT ST STE 114
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1491
Mailing Address - Country:US
Mailing Address - Phone:434-977-9711
Mailing Address - Fax:434-235-4142
Practice Address - Street 1:75 MEDICAL PARK LN STE C
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-6673
Practice Address - Country:US
Practice Address - Phone:828-516-1104
Practice Address - Fax:828-516-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X
HC1333251E00000X
NCHC0318251G00000X
NCHC0275251B00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Yes251G00000XAgenciesHospice Care, Community Based
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1588640890Medicaid
NC3408653OtherMEDICAID CAP
00740OtherBLUE CROSS
NC3411554Medicaid
NC3427014Medicaid
341554OtherMEDICARE HOSPICE
0021POtherBLUE CROSS HOSPICE
NC3408653OtherMEDICAID CAP
347014Medicare ID - Type Unspecified
NC347014Medicare Oscar/Certification