NPIMap

Organization Active NPI

Countryside Hospice Care, Inc.

Doing business as Countryside Hospice-Decatur

  • Community Based Hospice Care Agency
  • Decatur, GA
National Provider Identifier
1508136862
Registry record updated Jan 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
01-1579PSL Issued in AL
Legal business name
COUNTRYSIDE HOSPICE CARE, INC.
Doing business as
Countryside Hospice-Decatur
Practice address
801 Church Street NE
Suites 6 and 7
Decatur, GA 35601-2400
Phone
(256) 432-2718
NPI assigned
Jan 4, 2012
Last updated
Jan 4, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2012

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

Authorized official

Name
Michael T. Berg, J.D.
Title
Corporate Secretary
Phone
(505) 821-3355

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 01-1579PSL AL Primary

Addresses

Primary practice location

801 Church Street NE
Suites 6 and 7
Decatur, GA 35601-2400

Mailing address

18831 Von Karman Blvd.
Suite 400
Irvine, CA 92612-1533
Phone (949) 255-7129

Other identifiers 1

IdentifierTypeStateIssuer
PIC1579EPSLMedicaidAL

Other names 1

  • Countryside Hospice-Decatur 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.

Locations

801 Church St NE
Ste 6
Decatur, AL 35601
Phone (256) 274-8222

NPI Registry JSON

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

{
    "created_epoch": "1325635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325635200000",
    "number": "1508136862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18831 VON KARMAN BLVD.",
            "address_2": "SUITE 400",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926121533",
            "telephone_number": "949-255-7129",
            "fax_number": "505-468-9250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 CHURCH STREET NE",
            "address_2": "SUITES 6 AND 7",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "356012400",
            "telephone_number": "256-432-2718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE HOSPICE CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-04",
        "last_updated": "2012-01-04",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "CORPORATE SECRETARY",
        "authorized_official_telephone_number": "505-821-3355",
        "authorized_official_credential": "J.D."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "AL",
            "license": "01-1579PSL",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PIC1579EPSL",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Countryside Hospice-Decatur",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 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.