1427548676 NPI number — SACRED JOURNEY HOSPICE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427548676 NPI number — SACRED JOURNEY HOSPICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SACRED JOURNEY HOSPICE, 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:
SACRED JOURNEY HOSPICE, INC.
Provider Other Organization Name Type Code:
4
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:
1427548676
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 N WHITTINGTON PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40222-7101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-394-2100
Provider Business Mailing Address Fax Number:
502-394-2159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 OAK HILL BLVD STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWNAN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30265-2314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-583-0717
Provider Business Practice Location Address Fax Number:
678-432-6995
Provider Enumeration Date:
05/14/2018

Additional Information

Authorized Official

Authorized Official Last Name:
WHOBREY
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
TYLER
Authorized Official Title or Position:
PROVIDER ENROLLMENT
Authorized Official Telephone Number:
502-630-7249

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  038-0446-H , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 315D00000X , with the licence number: 038-0446-H , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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