Healthcare Provider Details

I. General information

NPI: 1821077017
Provider Name (Legal Business Name): HEARTH HEALTHCARE OF GEORGIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 CRYE LEIKE DR
FORT OGLETHORPE GA
30742-4055
US

IV. Provider business mailing address

500 FAULCONER DR STE 200
CHARLOTTESVILLE VA
22903-5089
US

V. Phone/Fax

Practice location:
  • Phone: 706-866-9854
  • Fax: 706-858-9371
Mailing address:
  • Phone: 434-977-9711
  • Fax: 434-235-4142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JESSE R MOORE
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 857-331-6271