Provider Demographics
NPI:1659392645
Name:SANCTUARY HOSPICE HOUSE, INC
Entity Type:Organization
Organization Name:SANCTUARY HOSPICE HOUSE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-844-2111
Mailing Address - Street 1:PO BOX 2177
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38803-2177
Mailing Address - Country:US
Mailing Address - Phone:662-844-2111
Mailing Address - Fax:662-844-2354
Practice Address - Street 1:5159 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-0200
Practice Address - Country:US
Practice Address - Phone:662-844-2111
Practice Address - Fax:662-844-2354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS136251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000070104OtherBLUE CROSS BLUE SHIELD
MS02904881Medicaid
MS02904881Medicaid