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COUNTRYSIDE HOSPICE CARE INC NPI 1639117690


NPI Information

NPI: 1639117690
Provider Name: COUNTRYSIDE HOSPICE CARE INC

Doing Business As: SOLAMOR HOSPICE SHARPSBURG

Classification: Hospice Care, Community Based - 251G00000X
Entity Type: Organization
Address:
820 EBENEZER CHURCH RD
SUITE 106
SHARPSBURG, GA
ZIP 30277
Phone: (770) 252-4999
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COUNTRYSIDE HOSPICE CARE INC is a hospice care community based in Sharpsburg, GA. COUNTRYSIDE HOSPICE CARE INC NPI is 1639117690. The provider is registered as an organization entity type.
The provider Is Doing Business As Solamor Hospice Sharpsburg.

The provider's business location address is:

820 EBENEZER CHURCH RD
SUITE 106
SHARPSBURG, GA
ZIP 30277-073
Phone: (770) 252-4999
Fax: (770) 252-4743

The provider's authorized official is Glen Cavallo .
The authorized official title is Sr. Vp - Operations and has the following contact phone number (479) 996-5900.

The enumeration date for this NPI number is 6/3/2006 and was last updated on 2/16/2012.


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
1251G00000XHospice Care, Community Based038156HGEORGIAYes

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
100894132AMEDICAIDGEORGIA
2111591MEDICARE ID-TYPE UNSPECIFIEDGEORGIAMEDICARE HOSPICE CERTIFIC
3038156HOTHERGEORGIAGEORGIA 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: 5/5/2024
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