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General NPI Number Information
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NPI Number | 1700193836
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Entity Type | Organization
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Legal Business Name | ALTUSCARE HOSPICE, INC.
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Dates
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Enumeration Date | 09/10/2010
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 151 N BAY VIEW DR
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City | VILLA RICA
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State | GA
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Zip | 30180-5144
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Country | US
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Telephone | 770-456-4643
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Fax | 770-456-4085
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Provider Business Mailing Address
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Address Line | 1 DUNWOODY PARK SUITE 128
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City | ATLANTA
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State | GA
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Zip | 30338-7404
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Country | US
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Telephone | 770-730-8405
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Fax | 770-730-8408
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Authorized Official
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Title or Position | CEO/CFO
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Name | DREW FORD ANDERSON
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Credential |
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Telephone | 770-730-8405
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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 | 022-0324-H
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License Number State | GA
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