Healthcare Provider Details

I. General information

NPI: 1427548676
Provider Name (Legal Business Name): SACRED JOURNEY HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 OAK HILL BLVD
NEWNAN GA
30265-2592
US

IV. Provider business mailing address

805 N WHITTINGTON PKWY
LOUISVILLE KY
40222-7101
US

V. Phone/Fax

Practice location:
  • Phone: 678-583-0717
  • Fax: 678-432-6995
Mailing address:
  • Phone: 502-394-2100
  • Fax: 502-394-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number038-0446-H
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number038-0446-H
License Number StateGA

VIII. Authorized Official

Name: MARGARET S PEMBERTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 502-272-3466