Provider Demographics
NPI:1942320262
Name:ALLIANCE HOSPICE, INC
Entity Type:Organization
Organization Name:ALLIANCE HOSPICE, INC
Other - Org Name:HEAVENLY HOSPICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:662-286-9833
Mailing Address - Street 1:909 S. FULTON STREET
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834
Mailing Address - Country:US
Mailing Address - Phone:662-286-9833
Mailing Address - Fax:662-286-9939
Practice Address - Street 1:909 S. FULTON STREET
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834
Practice Address - Country:US
Practice Address - Phone:662-286-9833
Practice Address - Fax:662-286-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01586856Medicaid
MS251648Medicare UPIN