Organization
ETERNITY HOSPICE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES L FAIRLEY (PRESIDENT)
(601) 517-0025
Entity
Organization
Contact information
Practice address
417 HIGHWAY 82 E STE 23, INDIANOLA, MS 38751-2315
(662) 887-3380
(662) 887-3739
Mailing address
PO BOX 686, INDIANOLA, MS 38751-0686
(662) 887-3380
(662) 887-3739
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
093
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09628359
—
MS
Enumeration date
06/22/2006
Last updated
11/13/2007
Update your record
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