Foglim Hospice LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

FOGLIM HOSPICE LLC

Practice address

125 Habersham Dr Ste C
Fayetteville, GA 30214-1382

Phone

(770) 558-1647

Fax

(470) 664-1006

NPI assigned

Oct 18, 2021

Organization subpart

No

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

Authorized official

Name

Mr. Ighiwiyisi Olaye

Title

Administrator

Phone

(678) 499-0759

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Hospice certification: CCN 851558

Legal name

FOGLIM HOSPICE LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Sep 28, 2022

Last certification

Sep 28, 2022

Ownership / control type

Proprietary - Corporation

Organization structure

LLCProprietary

Incorporated

Jun 7, 2021 in GA

Enrollment address

125 Habersham Dr
Unit C
Fayetteville, GA 30214-1382

Listed as

Foglim Hospice, LLCCCN 851558

Certified

Sep 28, 2022

Medicare certification status

ActiveFrom the Provider of Services file

Locations

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.

Affiliated clinicians 1

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

• Darrell Lee Murray Sr., M.D.

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1447250170

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1634515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691366400000",
    "number": "1083377055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 HABERSHAM DR STE C",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302141382",
            "telephone_number": "678-499-0759",
            "fax_number": "470-664-1006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 HABERSHAM DR STE C",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302141382",
            "telephone_number": "770-558-1647",
            "fax_number": "470-664-1006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOGLIM HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-18",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A",
        "authorized_official_last_name": "OLAYE",
        "authorized_official_first_name": "IGHIWIYISI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "678-499-0759",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sherry K Flowers, RN, CNM
• Floyd Davis, MD, PC
• Amanda Lee Floyd, LAPC
• Janine Foerster, D.C.
• Tara Austin Fogle, D.M.D.
• Connie Forbes, LMT
• Tucker Keith Forbes, ATC
• Arish Ford
• Fianna Ford, PA-C
• Paula Michelle Forrester, M.ED

• Community Based Hospice Care Agency in Fayetteville, GA
• Providers in Fayetteville, 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 Aug 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.