# ASERACARE HOSPICE - JACKSON LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Prime by AseraCare
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790115756
- **Authorized official:** PAUL KUSSEROW (PRESIDENT)
- **Authorized official phone:** (225) 292-2031

## Contact information

- **Practice address:** 1201 MONTLIMAR DR, STE 100, MOBILE, AL 36609-1704
- **Practice address phone:** (251) 343-0989
- **Mailing address:** 3854 AMERICAN WAY STE A, BATON ROUGE, LA 70816-4897
- **Mailing address phone:** (225) 292-2031
- **Mailing address fax:** (225) 295-9678

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207PH0002X | Hospice and Palliative Medicine (Emergency Medicine) Physician | — | NULL | — |
| 207PH0002X | Hospice and Palliative Medicine (Emergency Medicine) Physician | — | — | — |
| 207QH0002X | Hospice and Palliative Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QH0002X | Hospice and Palliative Medicine (Family Medicine) Physician | — | — | Yes |
| 207RH0002X | Hospice and Palliative Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RH0002X | Hospice and Palliative Medicine (Internal Medicine) Physician | — | — | — |
| 2081H0002X | Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081H0002X | Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |

## Other

- **Enumeration date:** 11/12/2013
- **Last updated:** 07/06/2020