Harbor Grace Hospice, Inc.

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

056-242-H Issued in GA

Legal business name

HARBOR GRACE HOSPICE, INC.

Practice address

500 W Lanier Ave
Suite 401
Fayetteville, GA 30214-7636

Phone

(678) 962-5850

Fax

(678) 962-5855

NPI assigned

Mar 16, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Jodi Wrenn, RN, CHPN

Title

Administrator

Phone

(678) 962-5850

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Hospice certification: CCN 111621

Legal name

HARBOR GRACE HOSPICE, INC.

Doing business as

HARBOR GRACE HOSPICE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Sep 12, 2005

Last certification

Oct 15, 2021

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Mar 25, 2004 in GA

Enrollment address

500 Lanier Ave W
Suite 401
Fayetteville, GA 30214-7638

Listed as

Harbor Grace Hospice, IncCCN 111621

Ownership

For-Profit

Certified

Sep 12, 2005

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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.

Owners & managing parties with NPI records 1

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

• Torey B Clark, M.D.

  • Specialist
  • Fayetteville, GA
  • NPI 1396737680

  5% Or Greater Direct Ownership Interest, Corporate Director

  CMS ownership

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Torey B Clark, M.D.

  • Specialist
  • Fayetteville, GA
  • NPI 1396737680
  NPD

Affiliated clinicians 1

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

• Paul Louis Desandre, DO

  • Emergency Medicine Physician
  • Decatur, GA
  • NPI 1255483756

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250121600000",
    "number": "1205960473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W LANIER AVE",
            "address_2": "SUITE 401",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147636",
            "telephone_number": "678-962-5850",
            "fax_number": "678-962-5855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W LANIER AVE",
            "address_2": "SUITE 401",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147636",
            "telephone_number": "678-962-5850",
            "fax_number": "678-962-5855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARBOR GRACE HOSPICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2009-08-13",
        "status": "A",
        "authorized_official_last_name": "WRENN",
        "authorized_official_first_name": "JODI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "678-962-5850",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN, CHPN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "GA",
            "license": "056-242-H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Russell Handberry Jr., RPH
• Hands on Healing PC
• Damien M Hansra, MD
• Lysa Mari Haraway, BCBA
• Meghan Harbin, LCSW
• Mitchell Hardesty, CPHT
• Gloria J. Hardiman
• Taylor Hardiman
• Annette Hardmon, OTRL
• Michaela Hargett-Thomas, RBT

• 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 13, 2009; 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.