Provider Demographics
NPI:1639890957
Name:NEVAEH HOSPICE
Entity Type:Organization
Organization Name:NEVAEH HOSPICE
Other - Org Name:NEVAEH HOMEMAKER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-719-2005
Mailing Address - Street 1:P.O. BOX 10
Mailing Address - Street 2:1165 EDWARD AVE. SUITE B
Mailing Address - City:MOUND BAYOU
Mailing Address - State:MS
Mailing Address - Zip Code:38762-0010
Mailing Address - Country:US
Mailing Address - Phone:662-719-2005
Mailing Address - Fax:662-741-2006
Practice Address - Street 1:116 S EDWARD AVE.
Practice Address - Street 2:116 S EDWARD AVE. SUITE B
Practice Address - City:MOUND BAYOU
Practice Address - State:MS
Practice Address - Zip Code:38762-0010
Practice Address - Country:US
Practice Address - Phone:662-719-2005
Practice Address - Fax:662-741-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty