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General NPI Number Information
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NPI Number | 1245953819
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Entity Type | Organization
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Legal Business Name | BLUE SUMMIT HOSPICE AND PALLIATIVE CARE, INC
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Dates
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Enumeration Date | 09/20/2022
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 2151 FOUNTAIN DR STE 306
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City | SNELLVILLE
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State | GA
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Zip | 30078-6752
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Country | US
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Telephone | 470-365-2657
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Fax | 470-359-5886
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Provider Business Mailing Address
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Address Line | 2151 FOUNTAIN DR STE 306
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City | SNELLVILLE
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State | GA
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Zip | 30078-6752
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Country | US
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Telephone | 470-365-2657
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Fax | 470-359-5886
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Authorized Official
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Title or Position | OWNER/ADMIN
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Name | AMANDA MCKISSICK
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Credential |
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Telephone | 470-365-2657
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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 |
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License Number State |
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