MEDICARE: CAMELLIA HOSPICE OF NORTHEAST ALABAMA, LLC

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

General Provider Information

NPI Number	:	1750792024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMELLIA HOSPICE OF NORTHEAST ALABAMA, LLC

Provider Business Mailing Address
First Line	:	6688 N CENTRAL EXPY STE 1300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-3950
Country	:	US
Telephone Number	:	214-239-6500
Fax Number	:	214-239-6581

Provider Business Practice Location Address
First Line	:	101 CHURCH ST STE A
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-6242
Country	:	US
Telephone Number	:	256-467-3568
Fax Number	:	256-442-9648

Authorized Official
Title or Position	:	EVP OF HOME HEALTH OPERATIONS
Name	:	JULIE DIANE JOLLEY
Credential	:
Telephone Number	:	214-239-6500

Provider Enumeration Date	:	05/08/2014
Last Update Date	:	12/10/2024

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