Countryside Hospice Care Inc
Organization Active NPI Community Based Hospice Care Agency · La Fayette, GA
NPI 1265470249 · NPPES record last updated Feb 16, 2012
Key facts
- NPI
- 1265470249
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- 146142H (GA)
- Legal business name
- COUNTRYSIDE HOSPICE CARE INC
- Practice address
- 106 Pearl Dr
Suite 107
La Fayette, GA 30728-7509 - Phone
- (706) 638-7651
- Fax
- (706) 638-7545
- NPI assigned
- Jun 3, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- COUNTRYSIDE HOSPICE CARE INC
Authorized official
- Name
- Mr. Glen Cavallo
- Title
- Sr. VP - Operations
- Phone
- (479) 996-5900
National Provider Directory
- Part of
- Countryside Hospice Care Inc
Locations
106 Pearl Dr
Ste 107
La Fayette, GA 30728
Phone (706) 639-1719
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 146142H | GA | Yes |
Addresses
Primary practice location
106 Pearl Dr
Suite 107
La Fayette, GA 30728-7509
Mailing address
101 Sun Ave NE
Albuquerque, NM 87109-4373
Phone (505) 468-5604
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00850044A | Medicaid | GA | |
| 146142H | Other | GA | GEORGIA HOSPICE LICENSE |
Other names
- SolAmor Hospice Lafayette
Other providers in La Fayette, GA
- Sarah Carson
- Abdul Chowdhury
- Clark Health Services LLC
- Leila Clark
- Consistent Care Family Practice
- Gwendolyn Abe De Leon
- Amanda Francis Deal
- Jimmie Denson
- Dialysis Clinic Inc.
- Courtney Durham
All providers in La Fayette, GA · Community Based Hospice Care Agency in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 16, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.