Healthcare Provider Details

I. General information

NPI: 1720972524
Provider Name (Legal Business Name): GRATEFUL HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 HUGH HOWELL RD STE 785
TUCKER GA
30084-4723
US

IV. Provider business mailing address

6340 ROBINS NEST
STONE MOUNTAIN GA
30087-4976
US

V. Phone/Fax

Practice location:
  • Phone: 678-592-4183
  • Fax: 470-945-2121
Mailing address:
  • Phone: 678-592-4183
  • Fax: 770-881-7503

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KAREN GAIL SMITH JACKSON
Title or Position: ADMINISTRATOR
Credential: REGISTERED NURSE
Phone: 678-592-4183