SOUTHEAST HOSPICE LLC NPI 1144600875

NPI Information

NPI: 1144600875
Provider Name: SOUTHEAST HOSPICE, LLC,

Doing Business As: SOUTHEAST HOSPICE

Classification: Hospice Care, Community Based - 251G00000X
Entity Type: Organization

Address:
1203 GEORGE C. WILSON DRIVE SUITE A
AUGUSTA, GA
ZIP 30909
Phone: (706) 364-3108
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SOUTHEAST HOSPICE, LLC, is a hospice care community based in Augusta, GA. SOUTHEAST HOSPICE, LLC, NPI is 1144600875. The provider is registered as an organization entity type.
The provider Is Doing Business As Southeast Hospice.

The provider's business location address is:

1203 GEORGE C. WILSON DRIVE SUITE A
AUGUSTA, GA
ZIP 30909-502
Phone: (706) 364-3108
Fax: (706) 364-3315

The provider's authorized official is Stuart Prather .
The authorized official title is Administrator and has the following contact phone number (706) 364-3108.

The CLIA number assigned to this NPI record is 11D2149820 - hospice with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/8/2015 and was last updated on 2/10/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	251G00000X	Hospice Care, Community Based		121-0416-H	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	111769	MEDICARE OSCAR/CERTIFICATION	GEORGIA
2	121-0416-H	OTHER	GEORGIA	GA HOSPICE LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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