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General NPI Number Information
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NPI Number | 1194028688
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Entity Type | Organization
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Legal Business Name | HEARTLITE HOSPICE ELLIJAY, INC.
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Dates
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Enumeration Date | 12/06/2010
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Last Update Date | 01/29/2013
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Provider Practice Location Address
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Address Line | 163 DALTON STREET
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City | EAST ELLIJAY
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State | GA
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Zip | 30540
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Country | US
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Telephone | 706-635-7001
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Fax | 706-635-7003
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Provider Business Mailing Address
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Address Line | 800 W. ROOSEVELT ROAD SUITE C-206
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City | GLEN ELLYN
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State | IL
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Zip | 60137-5851
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Country | US
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Telephone | 630-942-0100
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Fax | 256-532-2398
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Authorized Official
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Title or Position | CFO
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Name | MR. CURTIS A DANEKAS
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Credential | CPA
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Telephone | 630-942-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 061-0343-H
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License Number State | GA
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