Revelation Hospice and Palliative Care, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

REVELATION HOSPICE AND PALLIATIVE CARE, LLC

Practice address

89 Delta Ave
Suite 104
Clarksdale, MS 38614-2749

Phone

(662) 719-9209

NPI assigned

Sep 30, 2009

Last updated

Sep 30, 2009By 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. Andre' Kirkland, RN

Title

Ceo

Phone

(662) 719-9209

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1254268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254268800000",
    "number": "1558695072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "89 DELTA AVE",
            "address_2": "SUITE 104",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386142749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "89 DELTA AVE",
            "address_2": "SUITE 104",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386142749",
            "telephone_number": "662-719-9209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVELATION HOSPICE AND PALLIATIVE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-30",
        "last_updated": "2009-09-30",
        "status": "A",
        "authorized_official_last_name": "KIRKLAND",
        "authorized_official_first_name": "ANDRE'",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-719-9209",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2009; 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.