Healthcare Provider Details

I. General information

NPI: 1023575032
Provider Name (Legal Business Name): LAKESIDE HOSPICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 E 10TH ST STE 200
ANNISTON AL
36207-4781
US

IV. Provider business mailing address

4010 MASTERS RD
PELL CITY AL
35128-7550
US

V. Phone/Fax

Practice location:
  • Phone: 256-541-5696
  • Fax:
Mailing address:
  • Phone: 52-884-1111
  • Fax: 205-884-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State

VIII. Authorized Official

Name: PAUL M GARING
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 205-884-1111