Provider Demographics
NPI:1669775375
Name:COMPASSIONATE CARE HOSPICE OF SOUTHERN MISSISSIPPI, LLC
Entity type:Organization
Organization Name:COMPASSIONATE CARE HOSPICE OF SOUTHERN MISSISSIPPI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-518-6814
Mailing Address - Street 1:261 CONNECTICUT DR
Mailing Address - Street 2:STE 1
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-4177
Mailing Address - Country:US
Mailing Address - Phone:609-518-6814
Mailing Address - Fax:609-239-2096
Practice Address - Street 1:113 JEFFERSON DAVIS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5103
Practice Address - Country:US
Practice Address - Phone:601-442-6800
Practice Address - Fax:601-336-1362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS251689Medicare Oscar/Certification