Provider Demographics
NPI:1902974298
Name:COMPASSIONATE HOSPICE CARE, LLC
Entity Type:Organization
Organization Name:COMPASSIONATE HOSPICE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMELLA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:601-923-8070
Mailing Address - Street 1:5935 HIGHWAY 18 W
Mailing Address - Street 2:SUITE A1
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39209-9625
Mailing Address - Country:US
Mailing Address - Phone:601-923-8070
Mailing Address - Fax:601-923-8075
Practice Address - Street 1:5935 HWY 18 W
Practice Address - Street 2:SUITE A1
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209-9626
Practice Address - Country:US
Practice Address - Phone:601-923-8070
Practice Address - Fax:601-923-8075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-03
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS139251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05408341Medicaid
MS05408341Medicaid