Provider Demographics
NPI:1861618787
Name:PRIME CARE HOSPICE, INC.
Entity type:Organization
Organization Name:PRIME CARE HOSPICE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:EIFLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-827-2765
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:HOLLANDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38748-0276
Mailing Address - Country:US
Mailing Address - Phone:662-827-2765
Mailing Address - Fax:662-827-5001
Practice Address - Street 1:316 N DAVIS AVE
Practice Address - Street 2:SUITE C
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2303
Practice Address - Country:US
Practice Address - Phone:662-846-7600
Practice Address - Fax:662-846-7606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS029251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770053Medicaid
MS251527Medicare ID - Type Unspecified
MS00770053Medicaid