Countryside Hospice Care, Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

028-0350-H Issued in GA

Legal business name

COUNTRYSIDE HOSPICE CARE, INC

Doing business as

SolAmor Hospice Canton

Practice address

203 Oakside LN
Building 203, Suite B
Canton, GA 30114-6407

Phone

(770) 704-9982

Fax

(770) 704-2755

NPI assigned

Jan 19, 2010

Last updated

Feb 16, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Glen Cavallo

Title

Sr. VP - Operations

Phone

(479) 996-5900

Specialties & licenses 1

Addresses

Other names 1

• SolAmor Hospice Canton Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1263859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329350400000",
    "number": "1013248814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 OAKSIDE LN",
            "address_2": "BUILDING 203-B",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301146407",
            "telephone_number": "770-704-9982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 OAKSIDE LN",
            "address_2": "BUILDING 203, SUITE B",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301146407",
            "telephone_number": "770-704-9982",
            "fax_number": "770-704-2755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE HOSPICE CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-19",
        "last_updated": "2012-02-16",
        "status": "A",
        "authorized_official_last_name": "CAVALLO",
        "authorized_official_first_name": "GLEN",
        "authorized_official_title_or_position": "SR. VP - OPERATIONS",
        "authorized_official_telephone_number": "479-996-5900",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "GA",
            "license": "028-0350-H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SolAmor Hospice Canton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Allison Renee' Cordts, LPC
• Core Medical LLC
• Shelli Cossel, LPC
• Jon Patrick Costales, LPC
• Ryan West Coulter, PHARMD
• Courtney E Sinclair MD PC
• Elizabeth P Covington, O.D.
• Joseph Cown
• Dawn Cox
• Louis Michael Cox, D.M.D.

• Community Based Hospice Care Agency in Canton, GA
• Providers in Canton, GA by specialty
• Community Based Hospice Care Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.