1225047087 NPI number — EMBRACING HOSPICE CARE OF SOUTH ATLANTA,LLC

Table of content: (NPI 1225047087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225047087 NPI number — EMBRACING HOSPICE CARE OF SOUTH ATLANTA,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMBRACING HOSPICE CARE OF SOUTH ATLANTA,LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EMBRACING HOSICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225047087
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 N LAURA ST
Provider Second Line Business Mailing Address:
STE 1800
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32202-3664
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-493-6745
Provider Business Mailing Address Fax Number:
904-262-4804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2340 PATRICK HENRY PKWY
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
MCDONOUGH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30253-4325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-961-2170
Provider Business Practice Location Address Fax Number:
678-961-2161
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FOGLE
Authorized Official First Name:
RICH
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
904-493-6745

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  067161H , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00965258A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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