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General NPI Number Information
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NPI Number | 1851605695
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Entity Type | Organization
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Legal Business Name | HEARTLITE HOSPICE CARE, INC
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Dates
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Enumeration Date | 08/04/2010
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Last Update Date | 08/04/2010
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Provider Practice Location Address
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Address Line | 583 HIGHLAND XING STE 100
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City | EAST ELLIJAY
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State | GA
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Zip | 30540-6402
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Country | US
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Telephone | 706-635-7001
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Fax | 706-635-7003
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Provider Business Mailing Address
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Address Line | 583 HIGHLAND XING STE 100
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City | EAST ELLIJAY
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State | GA
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Zip | 30540-6402
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Country | US
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Telephone | 706-635-7001
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Fax | 706-635-7003
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Authorized Official
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Title or Position | VP FOR CLINICAL AFFAIRS
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Name | MR. M. B. HOPKINS
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Credential | BSN, RN
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Telephone | 706-847-5700
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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 | 061-0343-H
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License Number State | GA
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