Provider Demographics
NPI:1689755548
Name:SINGING RIVER HEALTH SYSTEM
Entity Type:Organization
Organization Name:SINGING RIVER HEALTH SYSTEM
Other - Org Name:HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-809-2074
Mailing Address - Street 1:2101 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5340
Mailing Address - Country:US
Mailing Address - Phone:228-497-2400
Mailing Address - Fax:
Practice Address - Street 1:1121 OCEAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3421
Practice Address - Country:US
Practice Address - Phone:228-818-2160
Practice Address - Fax:228-872-7768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770034Medicaid
MS000070009OtherBLUE CROSS OF MS
MS=========-010OtherCHAMPUS/TRICARE