Circle of Friends Hospice LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

067-0396-H Issued in GA

Legal business name

CIRCLE OF FRIENDS HOSPICE LLC

Doing business as

Circle of Friends Hospice
Hospice360

Practice address

833 Campbell Hill St NW Ste 114
Marietta, GA 30060-1135

Phone

(770) 545-8226

Fax

(770) 545-8227

NPI assigned

Sep 24, 2014

Organization subpart

No

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

Authorized official

Name

Charles David Rudder, RN

Title

Administrator

Phone

(770) 545-8226

Specialties & licenses 1

Addresses

Other names 2

• Circle of Friends Hospice Doing business as
• Hospice360 Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Hospice certification: CCN 111757

Legal name

CIRCLE OF FRIENDS HOSPICE LLC

Doing business as

HOSPICE360

Certification status

Active

Provider type (POS)

Hospice

Participating since

Jan 29, 2015

Last certification

Mar 1, 2021

Ownership / control type

Proprietary - Partnership

Organization structure

LLCProprietary

Incorporated

Jul 31, 2013 in GA

Enrollment address

833 Campbell Hill St NW
Ste 114
Marietta, GA 30060-1135

Listed as

Hospice360CCN 111757

Ownership

For-Profit

Certified

Jan 29, 2015

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 10

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

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Bryan D Hooker, MD

  • Internal Medicine Physician
  • Jasper, GA
  • NPI 1083600605

  Contracted Managing Employee

  CMS ownership

Affiliated clinicians 2

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

• Carl Goolsby Jr., MD

  • Family Medicine Physician
  • Hiram, GA
  • NPI 1174505390

  Hospice

  Care Compare affiliation
• Bryan D Hooker, MD

  • Internal Medicine Physician
  • Jasper, GA
  • NPI 1083600605

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1411516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705190400000",
    "number": "1184026866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 CAMPBELL HILL ST NW STE 114",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601135",
            "telephone_number": "770-545-8226",
            "fax_number": "770-545-8227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 CAMPBELL HILL ST NW STE 114",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601135",
            "telephone_number": "770-545-8226",
            "fax_number": "770-545-8227"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5835 Live Oak Pkwy Ste C",
            "address_purpose": "LOCATION",
            "city": "Norcross",
            "state": "GA",
            "postal_code": "300931727",
            "country_code": "US",
            "telephone_number": "770-545-8226",
            "fax_number": "770-545-8227",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "315 Scenic Hwy",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Lawrenceville",
            "state": "GA",
            "postal_code": "300465672",
            "country_code": "US",
            "telephone_number": "770-545-8226",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CIRCLE OF FRIENDS HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-24",
        "last_updated": "2024-01-14",
        "certification_date": "2024-01-14",
        "status": "A",
        "authorized_official_last_name": "RUDDER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "770-545-8226",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "GA",
            "license": "067-0396-H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Circle of Friends Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Circle of Friends Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hospice360",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community Based Hospice Care Agency in Marietta, GA
• Providers in Marietta, 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 Jan 14, 2024; 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.