Provider Demographics
NPI:1740347335
Name:NEW-ERA HOSPICE, LLC
Entity type:Organization
Organization Name:NEW-ERA HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NGOZI
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-342-7023
Mailing Address - Street 1:PO BOX 1229
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-0112
Mailing Address - Country:US
Mailing Address - Phone:662-342-7023
Mailing Address - Fax:
Practice Address - Street 1:8869 CENTRE ST
Practice Address - Street 2:3 & 4
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-1725
Practice Address - Country:US
Practice Address - Phone:662-342-7023
Practice Address - Fax:662-342-7089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS145251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS251636Medicare ID - Type UnspecifiedHOSPICE IDENTIFICATION NU