Provider Demographics
NPI:1801812185
Name:HOSPICE CARE GROUP, LLC
Entity type:Organization
Organization Name:HOSPICE CARE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ZDENEK
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:601-776-8880
Mailing Address - Street 1:114 E DONALD ST
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39355-2025
Mailing Address - Country:US
Mailing Address - Phone:601-776-8880
Mailing Address - Fax:601-776-8881
Practice Address - Street 1:114 E DONALD ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:MS
Practice Address - Zip Code:39355-2025
Practice Address - Country:US
Practice Address - Phone:601-776-8880
Practice Address - Fax:601-776-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08673266Medicaid
MS08673266Medicaid