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General NPI Number Information
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NPI Number | 1649505173
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Entity Type | Organization
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Legal Business Name | OAKBROOK HOSPICE OF GEORGIA, LLC
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Dates
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Enumeration Date | 10/16/2009
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Last Update Date | 03/24/2010
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Provider Practice Location Address
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Address Line | 660 W BANKHEAD HWY STE E
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City | VILLA RICA
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State | GA
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Zip | 30180-1606
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Country | US
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Telephone | 678-840-4333
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Fax | 678-840-5090
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Provider Business Mailing Address
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Address Line | 660 W BANKHEAD HWY STE E
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City | VILLA RICA
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State | GA
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Zip | 30180-1606
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Country | US
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Telephone | 678-840-4333
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Fax | 678-840-5090
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Authorized Official
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Title or Position | CEO
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Name | MR. GLEN SIDER
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Credential |
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Telephone | 914-390-4380
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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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