Provider Demographics
NPI:1871889964
Name:HOLISTIC CARE HOSPICE OF JACKSON LLC
Entity type:Organization
Organization Name:HOLISTIC CARE HOSPICE OF JACKSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-985-7291
Mailing Address - Street 1:PO BOX 720681
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-0681
Mailing Address - Country:US
Mailing Address - Phone:601-346-7737
Mailing Address - Fax:601-346-6333
Practice Address - Street 1:1757 UNIVERSITY BLVD
Practice Address - Street 2:3
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3916
Practice Address - Country:US
Practice Address - Phone:601-346-7737
Practice Address - Fax:601-346-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient