Healthcare Provider Details

I. General information

NPI: 1306919683
Provider Name (Legal Business Name): SACRED JOURNEY HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 PEACH DR
MCDONOUGH GA
30253
US

IV. Provider business mailing address

805 N WHITTINGTON PKWY
LOUISVILLE KY
40222-5186
US

V. Phone/Fax

Practice location:
  • Phone: 678-583-0717
  • Fax: 678-583-0712
Mailing address:
  • Phone: 502-394-2100
  • Fax: 502-394-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number075176H
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number075176H
License Number StateGA

VIII. Authorized Official

Name: TIMOTHY WHOBREY
Title or Position: PROVIDER ENROLLMENT
Credential:
Phone: 502-630-7249