Active NPI
Memorial Hospice Inc
- Pediatric Skilled Nursing Facility
- Clarksdale, MS
National Provider Identifier
1538249792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Skilled Nursing Facility
- Legal business name
- MEMORIAL HOSPICE INC
- Practice address
- 600 Ohio Street
Clarksdale, MS 38614 - Phone
- (662) 624-2872
- Fax
- (662) 627-7629
- NPI assigned
- Oct 16, 2006
- Reactivated
- Aug 2, 2007
- Organization subpart
- Yes
- Parent organization
- MEMORIAL HOSPICE INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Vanella Noah Campbell, LPN
- Title
- Ceo
- Phone
- (662) 624-2872
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Skilled Nursing Facility | 3140N1450X | Primary |
Addresses
Primary practice location
600 Ohio Street
Clarksdale, MS 38614
Mailing address
Post Office Box 1726
600 Ohio Street
Clarksdale, MS 38614
Phone (662) 624-2872
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09586879 | Medicaid | MS |
Other names 1
- Memorial Hospice Inpatient Facility
National Provider Directory
National Provider Directory- Part of
- Memorial Hospice Inc
Locations
600 Ohio Ave
Ofc Box
Clarksdale, MS 38614
712 Highway 82 W
Ofc C
Greenwood, MS 38930
Phone (662) 453-4505
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Community Based Hospice Care Agency
- Greenwood, MS
- NPI 1891022844
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1186012800000",
"number": "1538249792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "POST OFFICE BOX 1726",
"address_2": "600 OHIO STREET",
"city": "CLARKSDALE",
"state": "MS",
"postal_code": "38614",
"telephone_number": "662-624-2872",
"fax_number": "662-627-7629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 OHIO STREET",
"city": "CLARKSDALE",
"state": "MS",
"postal_code": "38614",
"telephone_number": "662-624-2872",
"fax_number": "662-627-7629"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEMORIAL HOSPICE INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MEMORIAL HOSPICE INC",
"enumeration_date": "2006-10-16",
"last_updated": "2007-08-02",
"deactivation_date": "2007-07-17",
"reactivation_date": "2007-08-02",
"status": "A",
"authorized_official_last_name": "CAMPBELL",
"authorized_official_first_name": "VANELLA",
"authorized_official_middle_name": "NOAH",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "662-624-2872",
"authorized_official_name_prefix": "Ms.",
"authorized_official_credential": "LPN"
},
"taxonomies": [
{
"code": "3140N1450X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility, Nursing Care, Pediatric",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "09586879",
"state": "MS"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Memorial Hospice Inpatient Facility",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Clarksdale, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 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.