Organization
LIFE SOURCE SERVICES, LLC
Active
Other names
Pax Hospice (Greenwood)
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RANDY BELTON (AUTHORIZED REPRESENTATIVE)
(601) 709-1408
Entity
Organization
Contact information
Practice address
115 FULTON ST, GREENWOOD, MS 38930-4361
(662) 451-9912
(662) 451-9915
Mailing address
115 FULTON ST, GREENWOOD, MS 38930-4361
(662) 451-9912
(662) 451-9915
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
126
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03332314
—
MS
Enumeration date
05/02/2006
Last updated
08/22/2020
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