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General NPI Number Information
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NPI Number | 1124417555
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Entity Type | Organization
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Legal Business Name | MABLEHOUSE HOSPICE
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Dates
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Enumeration Date | 01/22/2015
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Last Update Date | 01/22/2015
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Provider Practice Location Address
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Address Line | 6405 THE TRL
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-4959
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Country | US
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Telephone | 770-875-5519
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Fax | 770-875-5519
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Provider Business Mailing Address
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Address Line | 6405 THE TRL
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-4959
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Country | US
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Telephone | 770-875-5519
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Fax | 770-875-5519
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Authorized Official
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Title or Position | CEO
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Name | MRS. ANITA MIRANDA JONES-GATES
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Credential | RN, MSN/MGHA
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Telephone | 770-875-5519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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