Provider Demographics
NPI:1780214734
Name:DIXIE PALLIATIVE CARE, LLC
Entity Type:Organization
Organization Name:DIXIE PALLIATIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:GIUSTINA
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-628-8347
Mailing Address - Street 1:352 E RIVERSIDE DR STE B3B
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-5808
Mailing Address - Country:US
Mailing Address - Phone:435-628-8347
Mailing Address - Fax:
Practice Address - Street 1:352 E RIVERSIDE DR STE B3B
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-5808
Practice Address - Country:US
Practice Address - Phone:435-628-8347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-17
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty