Organization
DIVINITY HOSPICE LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD H PUGH SR. (CEO)
(601) 319-1211
Entity
Organization
Contact information
Practice address
337 ELLISVILLE BLVD, LAUREL, MS 39440-4523
(601) 319-1211
Mailing address
PO BOX 6424, LAUREL, MS 39441-6424
(601) 319-1211
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
199
MS
Other
Enumeration date
12/27/2010
Last updated
12/27/2010
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