NPIMap

Organization Active NPI

Cornerstone Hospice and Palliative Care of Georgia, LLC

  • Community Based Hospice Care Agency
  • Marietta, GA
National Provider Identifier
1417501834
Registry record updated Mar 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
CORNERSTONE HOSPICE AND PALLIATIVE CARE OF GEORGIA, LLC
Practice address
1225 Johnson Ferry Rd., BLDG. 100, Suite 160
Marietta, GA 30068
Phone
(678) 402-0005
NPI assigned
Jul 25, 2019
Last updated
Mar 30, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
CORNERSTONE HOSPICE & PALLIATIVE CARE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 30, 2020

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

Authorized official

Name
Mr. Charles O. Lee
Title
President/Ceo
Phone
(352) 343-1341

Specialties & licenses 1

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

Addresses

Primary practice location

1225 Johnson Ferry Rd., BLDG. 100, Suite 160
Marietta, GA 30068

Mailing address

2445 Lane Park Rd
Tavares, FL 32778-9648
Phone (352) 343-1341

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200221002705 GA Part A Provider - Hospice 5890122394 Practice locations: Marietta, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417501834. Details of each certification follow.

Hospice certification: CCN 851526

Legal name
CORNERSTONE HOSPICE AND PALLIATIVE CARE OF GEORGIA, LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
May 4, 2020
Last certification
Aug 17, 2021
Ownership / control type
Proprietary - Individual
Organization structure
LLCNon-profit
Incorporated
Mar 8, 2019 in FL
Enrollment address
1225 Johnson Ferry Rd.
BLDG. 100 Suite 160
Marietta, GA 30068-2774

Care Compare: Hospice

Medicare Care Compare
Listed as
Cornerstone Hospice & Palliative Care of GeorgiaCCN 851526 · All quality measures
Ownership
Non-Profit
Certified
May 4, 2020
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
11D2175448Cornerstone Hospice & Palliative Care of Ga, LLC1225 Johnson Ferry Road, Building 100, Suite 160, Marietta, GA 30068Certificate of waiverNov 20, 2027

National Provider Directory

National Provider Directory
Part of
Lake Hospice Inc

Locations

2445 Lane Park Rd
Tavares, FL 32778
Phone (866) 280-9355

1225 Johnson Ferry Rd
Ste 160
Marietta, GA 30068
Phone (678) 402-0005

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22792/brand/2/csg/2/fhir/r4

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Michael Howell Individual Corporate Director Jun 12, 2024
Tara Friedman Individual Corporate OfficerChief Medical Officer Jun 12, 2024
Heath Nailos Individual Corporate Director Jun 12, 2024
Chapters Health System Inc Organization, Temple Terrace, FL Non-profit Operational/Managerial Control Apr 1, 2022
Andrew K Molosky Individual Corporate Officer Jun 12, 2024
Corporate DirectorPresident/Ceo Jun 12, 2024
Todd a Webb Individual Corporate OfficerChief Financial Officer Jun 12, 2024
Corporate Director Jun 12, 2024
Rhonda G White Individual Corporate OfficerPresident, Hospice & Pace Jun 12, 2024
Corporate Director Jun 12, 2024
Valerie Zolman Individual Corporate OfficerChief Compliance Officer Jun 12, 2024
Franklin Guerrero Individual Corporate Officer Jun 12, 2024
Tige R Buchanan Individual Corporate OfficerChairman Jun 12, 2024
Corporate Director Jun 12, 2024
Thomas G Chase Individual Corporate OfficerVice Chair Jun 12, 2024
Corporate Director Jun 12, 2024
Wendy Y Terry Individual Corporate Director Jun 12, 2024
Cornerstone Hospice & Palliative Care Inc Organization, Tavares, FL Non-profit, Chain home office Operational/Managerial Control Mar 18, 2019
Jason M D'Auria Individual Contracted Managing EmployeeAd; Jun 30, 2025
Corporate OfficerCoo, Hospice Jun 12, 2024
Sheri Strobel Individual Corporate Officer Jun 12, 2024
Anthony Kamus Individual Corporate Director Jun 12, 2024
Nicole Romence Individual Corporate Officer Jun 12, 2024
Crystal Bucciarelli Individual Contracted Managing EmployeeVP, Legal Services Apr 1, 2022
Corporate Director Apr 1, 2022
Viju Varghese Individual Contracted Managing EmployeeMD; Apr 1, 2024
Cindy Burton Individual Corporate DirectorExecutive Director Jun 25, 2025

Owners & managing parties with NPI records 3

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

Facilities with the same owner 10

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

Practitioners & affiliated clinicians

Affiliated clinicians 2

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": "1564012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585526400000",
    "number": "1417501834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2445 LANE PARK RD",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327789648",
            "telephone_number": "352-343-1341",
            "fax_number": "352-343-6115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 JOHNSON FERRY RD., BLDG. 100, SUITE 160",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "30068",
            "telephone_number": "678-402-0005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNERSTONE HOSPICE AND PALLIATIVE CARE OF GEORGIA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CORNERSTONE HOSPICE & PALLIATIVE CARE INC",
        "enumeration_date": "2019-07-25",
        "last_updated": "2020-03-30",
        "certification_date": "2020-03-30",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "352-343-1341",
        "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": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.