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General NPI Number Information
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NPI Number | 1487935672
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Entity Type | Organization
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Legal Business Name | COMFORT CARE HOSPICE
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Dates
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Enumeration Date | 09/01/2011
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Last Update Date | 03/16/2012
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Provider Practice Location Address
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Address Line | 88 HERITAGE ST
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City | BAXLEY
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State | GA
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Zip | 31513-0012
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Country | US
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Telephone | 912-367-4146
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Fax | 912-367-4147
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Provider Business Mailing Address
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Address Line | 88 HERITAGE ST
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City | BAXLEY
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State | GA
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Zip | 31513-0012
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Country | US
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Telephone | 912-367-4146
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Fax | 912-367-4147
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. ANGIE DELORIS POTTS
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Credential | RN BSN
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Telephone | 912-367-4146
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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 | 001-346-H
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License Number State | GA
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