MEDICARE: LAKESIDE HOSPICE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency
2	251G00000X	Community Based Hospice Care Agency	10266	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	010-727	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1346244399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKESIDE HOSPICE INC.

Provider Business Mailing Address
First Line	:	4010 MASTERS RD
Second Line	:
City	:	PELL CITY
State	:	AL
Zip	:	35128-7550
Country	:	US
Telephone Number	:	205-884-1111
Fax Number	:	205-884-1114

Provider Business Practice Location Address
First Line	:	4010 MASTERS RD
Second Line	:
City	:	PELL CITY
State	:	AL
Zip	:	35128-7550
Country	:	US
Telephone Number	:	205-884-1111
Fax Number	:	205-884-1114

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	PAUL M GARING
Credential	:
Telephone Number	:	205-884-1111

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	02/04/2019

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Directions to “LAKESIDE HOSPICE INC. ” Practice Location

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