Provider Demographics
NPI:1821429275
Name:GTPDD HOSPICE
Entity Type:Organization
Organization Name:GTPDD HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUPERT 'RUDY'
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-324-7860
Mailing Address - Street 1:106 MILEY DR
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-7728
Mailing Address - Country:US
Mailing Address - Phone:662-324-7860
Mailing Address - Fax:662-324-1911
Practice Address - Street 1:106 MILEY DR
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-7728
Practice Address - Country:US
Practice Address - Phone:662-324-7860
Practice Address - Fax:662-324-1911
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GTPDD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based