Active NPI
New Covenant Hospice, LLC
- Community Based Hospice Care Agency
- Cleveland, MS
National Provider Identifier
1801955356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- Legal business name
- NEW COVENANT HOSPICE, LLC
- Practice address
- 804 1St St
Suite 1
Cleveland, MS 38732-2310 - Phone
- (662) 843-3395
- Fax
- (662) 843-3903
- NPI assigned
- Dec 8, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Richard Keyes
- Title
- Managing Member
- Phone
- (662) 843-3395
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Primary |
Addresses
Primary practice location
804 1St St
Suite 1
Cleveland, MS 38732-2310
Mailing address
804 1St St
Suite 1
Cleveland, MS 38732-2310
Phone (662) 843-3395
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 06157753 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090624000514 | MS | Part A Provider - Hospice | 8820090863 | Practice locations: Hollandale, MS |
Hospice certification: CCN 251641
- Legal name
- NEW COVENANT HOSPICE, LLC
- Doing business as
- GRACE COMMUNITY HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Feb 23, 2007
- Last certification
- Jan 6, 2022
- Ownership / control type
- Proprietary - Other
- Organization structure
- LLC
- Enrollment address
- 1116 East Ave N
Hollandale, MS 38748-3200
Care Compare: Hospice
Medicare Care Compare- Listed as
- Grace Community Hospice
- Ownership
- For-Profit
- Certified
- Feb 23, 2007
- Medicare certification status
- Active
National Provider Directory
National Provider DirectoryLocations
808 E Sunflower Rd
Cleveland, MS 38732
Phone (662) 846-7600
804 1st St
#1
Cleveland, MS 38732
Phone (662) 843-3395
804 1st St
Ste 1
Cleveland, MS 38732
Phone (662) 843-3395
1116 East Ave N
Hollandale, MS 38748
Phone (662) 827-0770
Ownership & related parties
All disclosed owners & managing parties 3
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Haley Eifling | Corporate Director | Nov 1, 2008 | 50% |
| W-2 Managing Employee | Nov 1, 2008 | 50% | |
| Justin Eifling | Corporate Director | Nov 1, 2008 | |
| W-2 Managing Employee | Nov 1, 2008 | ||
| New Covenant Hospice, LLC | General Partnership Interest | Nov 1, 2008 |
Practitioners & affiliated clinicians
Affiliated clinicians 8
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165536000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1197936000000",
"number": "1801955356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "804 1ST ST",
"address_2": "SUITE 1",
"city": "CLEVELAND",
"state": "MS",
"postal_code": "387322310",
"telephone_number": "662-843-3395",
"fax_number": "662-843-3903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "804 1ST ST",
"address_2": "SUITE 1",
"city": "CLEVELAND",
"state": "MS",
"postal_code": "387322310",
"telephone_number": "662-843-3395",
"fax_number": "662-843-3903"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NEW COVENANT HOSPICE, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-08",
"last_updated": "2007-12-18",
"status": "A",
"authorized_official_last_name": "KEYES",
"authorized_official_first_name": "RICHARD",
"authorized_official_title_or_position": "MANAGING MEMBER",
"authorized_official_telephone_number": "662-843-3395",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "06157753",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, MS
- Ms State Hospital Crisis Intervention Center - Clevenlan
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- Scott Nelson, MD
- Jasanda Wyketta Netter, M.S., CCC-SLP
- New Perspective Counseling and Consultation, LLC
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Sources for this page
- 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.