Eternity Hospice Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

127 Issued in MS

Legal business name

ETERNITY HOSPICE INC

Practice address

337 Ellisville Blvd
Laurel, MS 39440-4523

Phone

(601) 649-4105

Fax

(601) 649-4045

NPI assigned

May 31, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Donald Pugh Sr.

Title

Vice President

Phone

(601) 517-0025

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1124065156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "337 ELLISVILLE BLVD",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404523",
            "telephone_number": "601-649-4105",
            "fax_number": "601-649-4045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "337 ELLISVILLE BLVD",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404523",
            "telephone_number": "601-649-4105",
            "fax_number": "601-649-4045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETERNITY HOSPICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2007-11-13",
        "status": "A",
        "authorized_official_last_name": "PUGH",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "601-517-0025",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MS",
            "license": "127",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00386341",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.