Provider Demographics
NPI:1629270871
Name:ANGEL OF MERCY HOSPICE
Entity Type:Organization
Organization Name:ANGEL OF MERCY HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:662-759-0702
Mailing Address - Street 1:314 COURT
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38769
Mailing Address - Country:US
Mailing Address - Phone:662-759-0702
Mailing Address - Fax:662-759-0703
Practice Address - Street 1:314 S COURT ST
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MS
Practice Address - Zip Code:38769
Practice Address - Country:US
Practice Address - Phone:662-759-0702
Practice Address - Fax:662-759-0703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based