Provider Demographics
NPI:1891022844
Name:MEMORIAL HOSPICE, INC.
Entity type:Organization
Organization Name:MEMORIAL HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:VANELLA
Authorized Official - Middle Name:N
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-624-2872
Mailing Address - Street 1:PO BOX 1726
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-8526
Mailing Address - Country:US
Mailing Address - Phone:662-624-2872
Mailing Address - Fax:662-627-7629
Practice Address - Street 1:712 HIGHWAY 82 W STE C
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-5028
Practice Address - Country:US
Practice Address - Phone:662-453-4505
Practice Address - Fax:662-453-4509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS088251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based