Atlanta Regional Hospice LLC
Organization Active NPI Community Based Hospice Care Agency · Lake City, GA
NPI 1003520925 · NPPES record last updated Jan 6, 2023
Key facts
- NPI
- 1003520925
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- ATLANTA REGIONAL HOSPICE LLC
- Practice address
- 5499 Jonesboro Rd Ste B3
Lake City, GA 30260-3553 - Phone
- (404) 530-9313
- NPI assigned
- Jan 6, 2023
- Organization subpart
- No
Authorized official
- Name
- Grissel Cruz-Albuoy
- Title
- Coo
- Phone
- (301) 693-4201
Practitioners 1
Affiliated clinicians 1
-
Faye Vargas Morris, M.D.
Medicare Care Compare: Hospice
- Listed as
- Atlanta Regional Hospice, LLC
- Certified
- Jun 22, 2023
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2274361 | Atlanta Regional Hospice LLC | Certificate of waiver | Jan 2, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Hospice certification: CCN 851575
- Legal name
- ATLANTA REGIONAL HOSPICE LLC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Jun 22, 2023
- Last certification
- Jun 22, 2023
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- Corporation · Proprietary
- Incorporated
- Feb 3, 2022 in GA
- Enrollment address
- 5499 Jonesboro Rd
Ste B3
Lake City, GA 30260-3553
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Margo Jacob |
5% Or Greater Direct Ownership Interest | Feb 3, 2022 | 34% |
| Corporate Officer |
Feb 3, 2022 | 34% | |
| Verna Lewandowski |
5% Or Greater Direct Ownership Interest | Feb 3, 2022 | 33% |
| Corporate Officer |
Feb 3, 2022 | 33% | |
| W-2 Managing Employee |
Feb 3, 2022 | 33% | |
| Grissel Cruz-Albuoy |
5% Or Greater Direct Ownership Interest | Feb 3, 2022 | 33% |
| Corporate Officer |
Feb 3, 2022 | 33% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230207003397 | GA | Part a Provider - Hospice | 7315319985 | Practice locations: Lake City, GA |
National Provider Directory
Locations
5499 Jonesboro Rd
Ste B3
Morrow, GA 30260
Phone (301) 693-4201
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
5499 Jonesboro Rd Ste B3
Lake City, GA 30260-3553
Mailing address
5499 Jonesboro Rd Ste B3
Lake City, GA 30260-3553
Phone (404) 530-9313
Other providers in Lake City, GA
- Advanced Medical Clinics, P.C.
- Atl Sport
- Huy Bao
- Amber Holly Bunch
- Cedar Tree Behavioral Health Services
- Dinkins Nutrition Consultant Services LLS
- Dana Florence
All providers in Lake City, GA · Community Based Hospice Care Agency in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 6, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.