NPIMap

Organization Active NPI

Life Source Services, LLC

  • Community Based Hospice Care Agency
  • Greenwood, MS
National Provider Identifier
1295793982
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
126 Issued in MS
Legal business name
LIFE SOURCE SERVICES, LLC
Practice address
115 Fulton St
Greenwood, MS 38930-4361
Phone
(662) 451-9912
Fax
(662) 451-9915
NPI assigned
May 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Randy Belton
Title
Authorized Representative
Phone
(601) 709-1408

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 126 MS Primary

Addresses

Primary practice location

115 Fulton St
Greenwood, MS 38930-4361

Mailing address

115 Fulton St
Greenwood, MS 38930-4361
Phone (662) 451-9912

Other identifiers 1

IdentifierTypeStateIssuer
03332314MedicaidMS

Other names 1

  • Pax Hospice (Greenwood) Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295793982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 FULTON ST",
            "city": "GREENWOOD",
            "state": "MS",
            "postal_code": "389304361",
            "telephone_number": "662-451-9912",
            "fax_number": "662-451-9915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 FULTON ST",
            "city": "GREENWOOD",
            "state": "MS",
            "postal_code": "389304361",
            "telephone_number": "662-451-9912",
            "fax_number": "662-451-9915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE SOURCE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BELTON",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "AUTHORIZED REPRESENTATIVE",
        "authorized_official_telephone_number": "601-709-1408",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MS",
            "license": "126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03332314",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pax Hospice (Greenwood)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenwood, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.