Countryside Hospice Care Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

038156H Issued in GA

Legal business name

COUNTRYSIDE HOSPICE CARE INC

Doing business as

SolAmor Hospice Sharpsburg

Practice address

820 Ebenezer Church Rd
Suite 106
Sharpsburg, GA 30277-2073

Phone

(770) 252-4999

Fax

(770) 252-4743

NPI assigned

Jun 3, 2006

Last updated

Feb 16, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Glen Cavallo

Title

Sr. VP - Operations

Phone

(479) 996-5900

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• SolAmor Hospice Sharpsburg Doing business as

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329350400000",
    "number": "1639117690",
    "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": "820 EBENEZER CHURCH RD",
            "address_2": "SUITE 106",
            "city": "SHARPSBURG",
            "state": "GA",
            "postal_code": "302772073",
            "telephone_number": "770-252-4999",
            "fax_number": "770-252-4743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE HOSPICE CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "GA",
            "license": "038156H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00894132A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA HOSPICE LICENSE",
            "identifier": "038156H",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SolAmor Hospice Sharpsburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community Based Hospice Care Agency in Sharpsburg, GA
• Providers in Sharpsburg, GA by specialty
• Community Based Hospice Care Agency in Georgia

• 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.