=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801138821
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PALLIATIVE CARE AT HOME, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2013
-----------------------------------------------------
Last Update Date | 03/21/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4800 ASHFORD DUNWOODY RD SUITE 150
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30338-4897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-892-7185
-----------------------------------------------------
Fax | 678-892-7184
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4800 ASHFORD DUNWOODY RD SUITE 150
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30338-4897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-892-7185
-----------------------------------------------------
Fax | 678-892-7184
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RICHARD K RICE SR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 678-892-7182
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------