NPIMap

Organization Active NPI

TMC Hospice Care, Inc.

  • Community Based Hospice Care Agency
  • Carrollton, GA
National Provider Identifier
1073538906
Registry record updated Oct 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
11-15-34 Issued in GA
Legal business name
TMC HOSPICE CARE, INC.
Practice address
100 Greenway Blvd Ste F
Carrollton, GA 30117-4358
Phone
(770) 834-5438
Fax
(770) 834-8956
NPI assigned
Jul 13, 2006
Last updated
Oct 2, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
TANNER MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 2, 2024

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

Authorized official

Name
Deborah Clarke Brock
Title
Director Home Health & Hospice
Phone
(770) 834-5438

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 11-15-34 GA Primary

Addresses

Primary practice location

100 Greenway Blvd Ste F
Carrollton, GA 30117-4358

Mailing address

109 Cedar St Ste C
Carrollton, GA 30117-2667
Phone (770) 812-5770

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090602000539 GA Part A Provider - Hospice 0941350565 Practice locations: Carrollton, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073538906. Details of each certification follow.

Hospice certification: CCN 111534

Legal name
TMC HOSPICE CARE, INC.
Doing business as
TMC HOSPICE CARE, INC.
Certification status
Active
Provider type (POS)
Hospice
Participating since
Feb 4, 1994
Last certification
Apr 22, 2022
Ownership / control type
Other
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1988 in GA
Enrollment address
100 Greenway Blvd
Ste F
Carrollton, GA 30117-4358

Care Compare: Hospice

Medicare Care Compare
Listed as
Hospice Care- a Part of TannerCCN 111534 · All quality measures
Ownership
Non-Profit
Certified
Feb 4, 1994
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Part of
TMC Franklin Fam HLTH C

Locations

100 Greenway Blvd
Carrollton, GA 30117

100 Greenway Blvd
Ste F
Carrollton, GA 30117
Phone (770) 214-2355

101 Clinic Ave
Carrollton, GA 30117
Phone (770) 214-2355

710 Dixie St
Carrollton, GA 30117
Phone (770) 214-2355

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Carol Crews Individual 5% Or Greater Indirect Ownership InterestCfo Feb 1, 2014
W-2 Managing EmployeeBoard of Directors Feb 1, 2014
Deborah Brock Individual Corporate DirectorDirector Home Health Hospice Jan 1, 2009

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727827200000",
    "number": "1073538906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 CEDAR ST STE C",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301172667",
            "telephone_number": "770-812-5770",
            "fax_number": "770-836-9600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 GREENWAY BLVD STE F",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174358",
            "telephone_number": "770-834-5438",
            "fax_number": "770-834-8956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TMC HOSPICE CARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TANNER MEDICAL CENTER",
        "enumeration_date": "2006-07-13",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A",
        "authorized_official_last_name": "BROCK",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "CLARKE",
        "authorized_official_title_or_position": "DIRECTOR HOME HEALTH & HOSPICE",
        "authorized_official_telephone_number": "770-834-5438"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "GA",
            "license": "11-15-34",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, GA

Sources for this page

Verify at the official NPI Registry.