Healthcare Provider Details

I. General information

NPI: 1932242260
Provider Name (Legal Business Name): VITAS HEALTHCARE CORPORATION OF GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 RIVEREDGE PKWY STE GL100
ATLANTA GA
30328-5812
US

IV. Provider business mailing address

3046 CORPORATE WAY
MIRAMAR FL
33025-6547
US

V. Phone/Fax

Practice location:
  • Phone: 404-843-6500
  • Fax: 404-843-6510
Mailing address:
  • Phone: 305-374-4143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number060-217-H
License Number StateGA

VIII. Authorized Official

Name: NICHOLAS WESTFALL
Title or Position: CEO
Credential:
Phone: 305-374-4143