Camellia Hospice of Northeast Mississippi, LLC
Organization Active NPI Community Based Hospice Care Agency · Tupelo, MS
NPI 1265710404 · NPPES record last updated Aug 27, 2026
Key facts
- NPI
- 1265710404
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- CAMELLIA HOSPICE OF NORTHEAST MISSISSIPPI, LLC
- Practice address
- 499 Gloster Creek VLG Ste I-7
Tupelo, MS 38801 - Phone
- (662) 844-2870
- Fax
- (662) 844-2871
- NPI assigned
- Jul 21, 2011
- Organization subpart
- Yes
- Parent organization (as reported)
- ENHABIT, INC.
Authorized official
- Name
- Lisa M Arbuckle
- Title
- Director, Licensing & Enrollment
- Phone
- (214) 239-6500
Owners & managing parties with NPI records 9
Member of 1
Facilities with the same owner 196
Affiliated clinicians 6
-
Joshua T Black, MD
-
John J. King, MD
-
Laura Washington, MD
Medicare Care Compare: Hospice
- Listed as
- Enhabit Hospice of Northeast Mississippi
- Ownership
- For-Profit
- Certified
- Nov 9, 2005
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D2041251 | Enhabit Hospice of Northeast Mississippi | Certificate of waiver | May 17, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Hospice certification: CCN 251618
- Legal name
- CAMELLIA HOSPICE OF NORTHEAST MISSISSIPPI, LLC
- Doing business as
- ENHABIT HOSPICE NORTHEAST MISSISSIPPI
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Nov 9, 2005
- Last certification
- Jul 1, 2021
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- LLC · Proprietary
- Enrollment address
- 499 Gloster Creek VLG
Ste I7
Tupelo, MS 38801-4709
All disclosed owners & managing parties 19
| Name | Role | Since | Share |
|---|---|---|---|
| Tanya R Marion |
Corporate Officer |
Jul 1, 2022 | |
| Enhabit Holdings, Inc. |
5% Or Greater Indirect Ownership Interest | Jul 1, 2022 | 100% |
| 8 Knots Management, LLC |
5% Or Greater Indirect Ownership Interest | Dec 31, 2024 | 8.81% |
| Deerfield Management Company LP |
5% Or Greater Indirect Ownership Interest | Dec 31, 2023 | 9.97% |
| Blackrock Inc |
5% Or Greater Indirect Ownership Interest | Dec 31, 2024 | 7.8% |
| Clinton L Washington |
Contracted Managing Employee |
Jun 17, 2022 | |
| Barbara a Jacobsmeyer |
Corporate Officer |
Jun 21, 2021 | |
| Operational/Managerial Control |
Jan 1, 2023 | ||
| Sarah W Braley |
Corporate Officer |
Feb 2, 2023 | |
| Julie D Jolley |
Corporate Officer |
Jun 4, 2021 | |
| Vanguard Group Inc |
5% Or Greater Indirect Ownership Interest | Dec 31, 2024 | 5.91% |
| Enhabit Inc |
5% Or Greater Indirect Ownership Interest | Jul 1, 2022 | 100% |
| Wells Fargo Bank, N.a. |
5% Or Greater Security Interest | Jun 30, 2022 | 100% |
| Tanya Prentice |
W-2 Managing Employee |
Dec 3, 2021 | |
| Advanced Homecare Management LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2022 | 100% |
| Dylan C Black |
Corporate Officer |
Feb 22, 2023 | |
| Eh Home Health of the Southeast, LLC |
5% Or Greater Direct Ownership Interest | May 1, 2018 | 100% |
| Jeanne L Kalvaitis |
Corporate Officer |
Jul 1, 2022 | |
| Ryan T Solomon |
Corporate Officer |
Dec 9, 2024 | |
| Sean P Richardson |
Corporate Officer |
Feb 22, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111231000003 | MS | Part a Provider - Hospice | 8224204862 | Practice locations: Columbus, MS; Tupelo, MS |
National Provider Directory
Locations
2309 Bluecutt Rd
Ste C
Columbus, MS 39705
Phone (662) 854-0020
2309 Bluecutt Rd
Columbus, MS 39705
2305 Bluecutt Rd
#C
Columbus, MS 39705
Phone (662) 854-0020
499 Gloster Creek Vlg
Ste 17
Tupelo, MS 38801
499 Gloster Creek Vlg
Ste I7
Tupelo, MS 38801
Phone (662) 844-2870
6688 N Central Expy
Ste 13
Dallas, TX 75206
Interoperability endpoints
- enhabit.hospice.ms.tph@direct.hchb.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | MS | Yes |
Addresses
Primary practice location
499 Gloster Creek VLG Ste I-7
Tupelo, MS 38801
Mailing address
6688 N Central Expy Ste 13
Dallas, TX 75206-3914
Phone (214) 239-6500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0177575 | Medicaid | MS |
Other names
- Enhabit Hospice of Northeast Mississippi
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ENHABIT.HOSPICE.MS.TPH@DIRECT.HCHB.COM | Health Information Exchange (HIE) |
Other providers in Tupelo, MS
- Jennifer Caldwell
- John Anthony Caldwell
- William B Calhoun
- James Forest Call Jr.
- William Lane Callahan
- Carrington Campbell
- Justin Campbell
- Luke Jameson Campbell
- Holly Williamson Cannon
- Kaye B Cannon
All providers in Tupelo, MS · Community Based Hospice Care Agency in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.