Organization
PROVIDENCE HOSPICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD E KEYES (MANAGING MEMBER)
(601) 956-9755
Entity
Organization
Contact information
Practice address
13 NORTHTOWN DR, SUITE 220, JACKSON, MS 39211-3047
(601) 956-9755
(601) 956-0743
Mailing address
13 NORTHTOWN DR, JACKSON, MS 39211-3047
(601) 956-9755
(601) 956-0743
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
090
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08734861
—
MS
Enumeration date
05/04/2006
Last updated
12/18/2007
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