Providence Hospice, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

090 Issued in MS

Legal business name

PROVIDENCE HOSPICE, LLC

Practice address

13 Northtown Dr
Suite 220
Jackson, MS 39211-3047

Phone

(601) 956-9755

Fax

(601) 956-0743

NPI assigned

May 4, 2006

Last updated

Dec 18, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Richard E Keyes

Title

Managing Member

Phone

(601) 956-9755

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197936000000",
    "number": "1548218738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 NORTHTOWN DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392113047",
            "telephone_number": "601-956-9755",
            "fax_number": "601-956-0743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 NORTHTOWN DR",
            "address_2": "SUITE 220",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392113047",
            "telephone_number": "601-956-9755",
            "fax_number": "601-956-0743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2007-12-18",
        "status": "A",
        "authorized_official_last_name": "KEYES",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "601-956-9755",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MS",
            "license": "090",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08734861",
            "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 Dec 18, 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.