Provider Demographics
NPI:1841450806
Name:ANGELIC HSOPICE CARE AND PALLATIVE CARE SERVICES, INC
Entity type:Organization
Organization Name:ANGELIC HSOPICE CARE AND PALLATIVE CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:662-453-5348
Mailing Address - Street 1:213 W JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-3557
Mailing Address - Country:US
Mailing Address - Phone:662-453-5348
Mailing Address - Fax:
Practice Address - Street 1:213 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-3557
Practice Address - Country:US
Practice Address - Phone:662-453-5348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based