NPIMap

Organization Active NPI

Empyrean Hospice of Georgia, LLC

  • Community Based Hospice Care Agency
  • Adel, GA
National Provider Identifier
1235910480
Registry record updated May 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
EMPYREAN HOSPICE OF GEORGIA, LLC
Practice address
1102 N Hutchinson Ave
Adel, GA 31620-1183
Phone
(229) 500-6250
NPI assigned
Oct 12, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2025

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

Authorized official

Name
Stephanie Baheth
Title
Cao
Phone
(980) 920-3676

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

1102 N Hutchinson Ave
Adel, GA 31620-1183

Mailing address

647 Brawley School Rd Ste 104
Mooresville, NC 28117-6876
Phone (980) 920-3611

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231026001353 GA Part A Provider - Hospice 2365801115 Practice locations: Adel, GA

Hospice certification: CCN 851593

Legal name
EMPYREAN HOSPICE OF GEORGIA, LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Mar 14, 2024
Last certification
Mar 14, 2024
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Enrollment address
108 S Pine St
Ste 108
Adel, GA 31620-2635

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Empyrean Hospice of Georgia, LLC-(Adel)CCN 851593
Certified
Mar 14, 2024
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2292291Empyrean Hospice of Georgia108 S Pine Street, Suite 108, Adel, GA 31620Certificate of waiverOct 23, 2027

National Provider Directory

National Provider Directory
Tax ID family
Empyrean Hospice of Georgia LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Empyrean Partners, LLC Organization, Mooresville, NC LLC 5% Or Greater Indirect Ownership Interest Jun 1, 2023 100%
Empyrean Hospice, LLC Organization, Mooresville, NC LLC 5% Or Greater Direct Ownership Interest Jun 1, 2023 100%
Stephanie Baheth Individual Corporate OfficerSecretary Dec 6, 2024 25%
Melissa Coleman Individual Corporate OfficerTreasurer Jan 1, 2025 25%
St Claire Gitau Sumaili Individual Contracted Managing EmployeeMD; Apr 1, 2025
Lisa Fletcher Individual W-2 Managing EmployeeAd; Dec 1, 2024
Empyrean Health Services, LLC Organization, Mooresville, NC LLC 5% Or Greater Indirect Ownership Interest Jun 1, 2023 100%
Larry R Graham Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2023 100%
Corporate OfficerPresident/Ceo Jan 1, 2025 50%
Operational/Managerial ControlPresident/Ceo Jan 1, 2025 100%
Empyrean Healthcare Holdings, LLC Organization, Mooresville, NC LLC 5% Or Greater Indirect Ownership Interest Jun 1, 2023 100%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1697068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748304000000",
    "number": "1235910480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "647 BRAWLEY SCHOOL RD STE 104",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281176876",
            "telephone_number": "980-920-3611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 N HUTCHINSON AVE",
            "city": "ADEL",
            "state": "GA",
            "postal_code": "316201183",
            "telephone_number": "229-500-6250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMPYREAN HOSPICE OF GEORGIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-12",
        "last_updated": "2025-05-27",
        "certification_date": "2025-05-27",
        "status": "A",
        "authorized_official_last_name": "BAHETH",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CAO",
        "authorized_official_telephone_number": "980-920-3676"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Adel, GA

Sources for this page

Verify at the official NPI Registry.