NPIMap

Organization Active NPI

Countryside Hospice Care, Inc

  • Community Based Hospice Care Agency
  • Stockbridge, GA
National Provider Identifier
1487950234
Registry record updated Feb 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
038156H Issued in GA
Legal business name
COUNTRYSIDE HOSPICE CARE, INC
Practice address
245 Country Club Dr
BLDG. 300a
Stockbridge, GA 30281-9080
Phone
(256) 231-9190
Fax
(256) 231-2350
NPI assigned
Jan 26, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2012

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

Authorized official

Name
Glen Cavallo
Title
Sr. VP - Operations
Phone
(479) 996-5900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 038156H GA Primary

Addresses

Primary practice location

245 Country Club Dr
BLDG. 300a
Stockbridge, GA 30281-9080

Mailing address

101 Sun Ave NE
Albuquerque, NM 87109-4373
Phone (505) 468-5604

Other identifiers 2

IdentifierTypeStateIssuer
038156HOtherGAGEORGIA HOSPICE LICENSE
000894132AMedicaidGA

Other names 1

  • SolAmor Hospice Stockbridge Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Countryside Hospice Care Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

NPI Registry JSON

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

{
    "created_epoch": "1296000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329350400000",
    "number": "1487950234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SUN AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094373",
            "telephone_number": "505-468-5604",
            "fax_number": "505-468-4681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 COUNTRY CLUB DR",
            "address_2": "BLDG. 300A",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302819080",
            "telephone_number": "256-231-9190",
            "fax_number": "256-231-2350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE HOSPICE CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-26",
        "last_updated": "2012-02-16",
        "status": "A",
        "authorized_official_last_name": "CAVALLO",
        "authorized_official_first_name": "GLEN",
        "authorized_official_title_or_position": "SR. VP - OPERATIONS",
        "authorized_official_telephone_number": "479-996-5900"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "GA",
            "license": "038156H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA HOSPICE LICENSE",
            "identifier": "038156H",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000894132A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SolAmor Hospice Stockbridge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stockbridge, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.