Healthcare Provider Details

I. General information

NPI: 1457066573
Provider Name (Legal Business Name): WESTSIDE HOSPICE & PALLIATIVE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5990 LOVE ST
AUSTELL GA
30168-4029
US

IV. Provider business mailing address

5990 LOVE ST
AUSTELL GA
30168-4029
US

V. Phone/Fax

Practice location:
  • Phone: 678-353-8528
  • Fax:
Mailing address:
  • Phone: 678-353-8528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State

VIII. Authorized Official

Name: ANITA PRINCE
Title or Position: ORGANIZER & MANAGER
Credential: NP
Phone: 678-353-8528