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General NPI Number Information
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NPI Number | 1871050054
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Entity Type | Organization
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Legal Business Name | MAGNOLIA HOSPICE OF MACON, LLC
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 1515 BASS RD STE G
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City | MACON
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State | GA
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Zip | 31210-7579
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Country | US
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Telephone | 470-281-8686
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Fax | 877-663-8423
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Provider Business Mailing Address
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Address Line | 6900 SW 80TH ST
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City | MIAMI
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State | FL
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Zip | 33143-4931
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Country | US
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Telephone | 305-591-1606
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Fax | 305-591-1618
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | ISMAEL ROQUE-VELASCO
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Credential |
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Telephone | 305-591-1606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315D00000X
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Taxonomy Name | Inpatient Hospice
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License Number |
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License Number State |
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Taxonomy #2
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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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