=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689303000
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | S&N COMPASSIONATE CARES HOSPICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2022
-----------------------------------------------------
Last Update Date | 06/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1640 POWERS FERRY RD SE BLDG 16 SUITE 200
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-889-2397
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2414 PALLADIAN MANOR WAY SE
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30339-6734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-889-2397
-----------------------------------------------------
Fax | 770-690-9094
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | ANYANGWE NKONGHONYOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 404-889-2397
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------