Provider Demographics
NPI:1962460568
Name:NORTH DELTA HOSPICE AND PALLIATIVE SERVICES,LLC
Entity Type:Organization
Organization Name:NORTH DELTA HOSPICE AND PALLIATIVE SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:E
Authorized Official - Last Name:VALLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-490-5999
Mailing Address - Street 1:PO BOX 1798
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-0019
Mailing Address - Country:US
Mailing Address - Phone:662-393-0170
Mailing Address - Fax:662-393-0171
Practice Address - Street 1:520 GOODMAN RD E
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9526
Practice Address - Country:US
Practice Address - Phone:662-393-0170
Practice Address - Fax:662-393-0171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS137251G00000X
315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS251626Medicare Oscar/Certification
MS251629Medicare Oscar/Certification