Provider Demographics
NPI:1902105976
Name:MERCY HOSPICE LLC
Entity Type:Organization
Organization Name:MERCY HOSPICE LLC
Other - Org Name:LEGACY HOSPICE OF THE SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF SYSTEMS AND CONTROL
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-652-6167
Mailing Address - Street 1:PO BOX 2130
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-2130
Mailing Address - Country:US
Mailing Address - Phone:334-686-0138
Mailing Address - Fax:205-652-9110
Practice Address - Street 1:1111 STARK RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3556
Practice Address - Country:US
Practice Address - Phone:662-338-0007
Practice Address - Fax:662-338-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS151251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05677023Medicaid
MS251638Medicare Oscar/Certification