Healthcare Provider Details

I. General information

NPI: 1023174919
Provider Name (Legal Business Name): HEART OF GEORGIA HOSPICE , INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 WESTRIDGE DR
WARNER ROBINS GA
31088-8111
US

IV. Provider business mailing address

103 WESTRIDGE DR
WARNER ROBINS GA
31088-8111
US

V. Phone/Fax

Practice location:
  • Phone: 478-953-5161
  • Fax: 478-953-5232
Mailing address:
  • Phone: 478-953-5161
  • Fax: 478-953-5232

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: MRS. MELISSA ABRAHAM
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 478-953-5161