MEMORIAL HOSPICE INC (NPI# 1538249792) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538249792 |
| Entity Type | Organization |
| Organization Name | MEMORIAL HOSPICE INC |
| Other Organization Name | MEMORIAL HOSPICE INPATIENT FACILITY |
| Practice Address |
600 Ohio Street Clarksdale MS 38614 |
| Mailing Address |
Post Office Box 1726 600 Ohio Street Clarksdale MS 38614 |
| Practice Telephone | 6626242872 |
| Practice Fax Number | 6626277629 |
| Mailing Telephone | 6626242872 |
| Mailing Fax Number | 6626277629 |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2007-08-02 |
| NPI Deactivation Date | 07/17/2007 |
| NPI Reactivation Date | 2007-08-02 |
| Authorized Official Name | MS. VANELLA NOAH CAMPBELL (CEO) |
| Authorized Official Telephone | 6626242872 |
| Authorized Official Credential | LPN |
| Is Organization Subpart | Y |
| Parent Organization Name | MEMORIAL HOSPICE INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3140N1450X |
Skilled Nursing Facility Specialization: Nursing Care, Pediatric |
Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 09586879 | 05 |
| Other Name | Type Code |
|---|---|
| Memorial Hospice Inpatient Facility | Other Name - Individual/Organization |
| Street Address |
600 OHIO STREET |
| City | CLARKSDALE |
| State | MS |
| Zip Code | 38614 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386265627 | Lillie Mae Lockett | Technician | 1025 Ritchie Ave, Clarksdale, MS 38614 | 2020-04-28 |
| 1063957751 | Autospa-healthy Youth Center | Nurse Practitioner | 1202 Desoto Ave, Suite A, Clarksdale, MS 38614 | 2017-01-04 |
| 1700226123 | Nikki Nikkia Cager | Internal Medicine | 785 Ohio Ave Ste 2d, Clarksdale, MS 38614 | 2013-06-29 |
| 1205186947 | Celestial Comfort Care Hospice | Hospice Care, Community Based | 110 Yazoo Ave. Suite 212, Clarksdale, MS 38614 | 2012-09-10 |
| 1063667129 | The Smile Center of Clarksdale | Clinic/Center | 526 Choctaw Street, Suites B & C, Clarksdale, MS 38614 | 2008-11-17 |
| 1801060033 | Clarksdale Municipal School District | Local Education Agency (LEA) | Gycelle Tynes Educational Center, Friars Point Road, Clarksdale, MS 38614 | 2008-04-18 |
| 1184806150 | Mary A Williams | Nurse Practitioner | 125 Highway 322, Clarksdale, MS 38614 | 2007-12-03 |
| 1114040367 | William F Wilson Jr. | Dentist | 850 Desoto Ave, Extended, Clarksdale, MS 38614 | 2007-04-10 |
| 1952434920 | Kathleen Tinnel | Nurse Practitioner | 2245 N State St, Clarksdale, MS 38614 | 2007-03-13 |
| 1497888457 | Carole L Mangrem | Pediatrics | 2245 N Starte St, Clarksdale, MS 38614 | 2007-03-13 |
| Find all providers in zip 38614 | ||||
| Taxonomy Code | 3140N1450X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| Specialization | Nursing Care, Pediatric |
| A nursing care facility designed and staffed for the provision of nursing care and appropriate educational and habilitative/rehabilitative services to children with multiple, complex or profound disabilities that can not be cared for in a less restrictive environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043858053 | Pediatric Haven | Skilled Nursing Facility | 112 Westfalen Drive, Canton, MS 39046 | 2019-12-20 |
| 1588104814 | Jackson County Pediatric Extended Care LLC | Skilled Nursing Facility | 2025 Jackson Ave, Pascagoula, MS 39567-4427 | 2017-03-06 |
| 1801256318 | Caring Hands Ppec of Vicksburg, LLC | Skilled Nursing Facility | 3419 Wisconsin Ave, Vicksburg, MS 39180-5330 | 2016-02-25 |
| 1538526140 | Desoto Pediatric Extended Care LLC | Skilled Nursing Facility | 750 Stateline Road East, Southhaven, MS 38671 | 2016-01-27 |
| 1609259936 | Meridian Pediatric Extended Care LLC | Skilled Nursing Facility | 3850 Highway 45 N, Meridian, MS 39301-1517 | 2015-07-06 |
| 1093198731 | Caring Hands Prescribed Pediatric | Skilled Nursing Facility | 371 Towne Center Pl, Ridgeland, MS 39157-4833 | 2015-06-30 |
| 1639606940 | Pediatrust Columbus, LLC | Skilled Nursing Facility | 306 Hospital Dr, Columbus, MS 39705-1935 | 2017-05-17 |
| 1437523511 | Delta Pediatric Care | Skilled Nursing Facility | 526 Fairview Ave, Greenville, MS 38701-5401 | 2015-11-30 |
| 1891107298 | Gulf Coast Pediatric Care LLC | Skilled Nursing Facility | 1285 Spring St, Gulfport, MS 39507-3423 | 2014-05-20 |
| City | CLARKSDALE |
| Zip Code | 38614 |
Please comment or provide details below to improve the information on MEMORIAL HOSPICE INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.