=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558589663
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRINITY HOSPICE OF GEORGIA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 41 PERIMETER CTR E SUITE 200
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30346-1910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-306-4500
-----------------------------------------------------
Fax | 214-853-5864
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14180 DALLAS PKWY SUITE 800
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75254-4341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-306-4500
-----------------------------------------------------
Fax | 214-853-5864
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | AMY M GLASSCOCK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-306-4520
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------