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General NPI Number Information
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NPI Number | 1356498737
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Entity Type | Organization
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Legal Business Name | MARMALADE HEALTHCARE LLC
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 215 AZALEA CT
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City | SOCIAL CIRCLE
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State | GA
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Zip | 30025-5037
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Country | US
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Telephone | 770-464-5858
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Fax | 770-464-5870
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Provider Business Mailing Address
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Address Line | 215 AZALEA CT
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City | SOCIAL CIRCLE
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State | GA
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Zip | 30025-5037
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Country | US
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Telephone | 770-464-5858
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Fax | 770-464-5870
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Authorized Official
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Title or Position | EXECUTIVE ADMINISTRATOR
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Name | ELLEN T PETRY
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Credential | RN
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Telephone | 770-464-5858
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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 | 107151H
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 315D00000X
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Taxonomy Name | Inpatient Hospice
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License Number | 107151H
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License Number State | GA
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