1730375049 NPI number — TRANSITIONS HOSPICE CARE OF GEORGIA, INC

Table of content: (NPI 1730375049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730375049 NPI number — TRANSITIONS HOSPICE CARE OF GEORGIA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRANSITIONS HOSPICE CARE OF GEORGIA, INC
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:
Provider Other Organization Name Type Code:
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:
1730375049
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 OAKSIDE DRIVE
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30114-2473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-704-0456
Provider Business Mailing Address Fax Number:
770-704-0304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 OAKSIDE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30114-2473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-704-0456
Provider Business Practice Location Address Fax Number:
770-704-0304
Provider Enumeration Date:
09/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOSSFELD
Authorized Official First Name:
ANITA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
706-378-2273

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 416872535B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 028-0299-H . This is a "STATE LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 11D1091870 . This is a "CLIA CERTIFICATE OF WAIVER" identifier . This identifiers is of the category "OTHER".




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