1881123701 NPI number — TAPESTRY HOSPICE OF FORT OGLETHORPE

Table of content: (NPI 1881123701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881123701 NPI number — TAPESTRY HOSPICE OF FORT OGLETHORPE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAPESTRY HOSPICE OF FORT OGLETHORPE
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:
TAPESTRY HOSPICE
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:
1881123701
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2950 CHEROKEE ST NW STE 900
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNESAW
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30144-6505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
470-221-0216
Provider Business Mailing Address Fax Number:
404-393-5586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4966 BATTLEFIELD PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RINGGOLD
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30736-8071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-858-1500
Provider Business Practice Location Address Fax Number:
706-858-7040
Provider Enumeration Date:
06/05/2017

Additional Information

Authorized Official

Authorized Official Last Name:
NALL
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
OWNER/CFO
Authorized Official Telephone Number:
678-672-8470

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)





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