Favor Hospice Care LLC
Organization Active NPI Community Based Hospice Care Agency · Sugar Hill, GA
NPI 1669713871 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1669713871
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- 067-0443-H (GA)
- Legal business name
- FAVOR HOSPICE CARE LLC
- Practice address
- 1400 Buford Hwy
Ste M3
Sugar Hill, GA 30518-8725 - Phone
- (901) 495-4456
- NPI assigned
- Mar 13, 2013
- Organization subpart
- No
Authorized official
- Name
- Adekunbi Adedipe
- Title
- Ceo
- Phone
- (901) 495-4456
Medicare Care Compare: Hospice
- Listed as
- Favor Hospice Care
- Ownership
- For-Profit
- Certified
- Apr 16, 2018
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Hospice certification: CCN 111795
- Legal name
- FAVOR HOSPICE CARE LLC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Apr 16, 2018
- Last certification
- May 26, 2021
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- LLC · Proprietary
- Incorporated
- Jun 30, 2017 in GA
- Enrollment address
- 1400 Buford Hwy
Ste M3
Buford, GA 30518-8725
All disclosed owners & managing parties 1
| Name | Role | Since | Share |
|---|---|---|---|
| Abekunbi Adedipe |
5% Or Greater Direct Ownership Interest |
Aug 1, 2022 | 100% |
| Corporate Officer |
Aug 1, 2022 | 100% | |
| W-2 Managing Employee |
Jan 1, 2023 | 100% | |
| Operational/Managerial Control |
Aug 1, 2022 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180126000214 | GA | Part a Provider - Hospice | 3072749050 | Practice locations: Buford, GA |
National Provider Directory
Locations
1400 Buford Hwy
Ste M3
Buford, GA 30518
Phone (470) 202-8533
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 067-0443-H | GA | Yes |
Addresses
Primary practice location
1400 Buford Hwy
Ste M3
Sugar Hill, GA 30518-8725
Mailing address
1400 Buford Hwy
Suite M-3
Sugar Hill, GA 30518-8725
Phone (901) 279-6442
Other practice location 1
108 Paradise Way
Suite A
Red Oak, TX 75154-8880
Phone (901) 279-6442
Other providers in Sugar Hill, GA
- Barbara An Eason
- Edlyn Healthcare Services, Inc
- John Joseph Edwards
- Brandon William Faieta
- Family and Youth Interventions, LLC
- Asma Ferdous
- Lori G Fiore
- Flowstate Revenue
- Angana Fofandi
- Dana Spinda Foley
All providers in Sugar Hill, 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 Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.