MEDICARE: LADAHMA HEALTH SYSTEMS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1033769518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LADAHMA HEALTH SYSTEMS LLC

Provider Business Mailing Address
First Line	:	1755 THE EXCHANGE SE STE 360D
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-7404
Country	:	US
Telephone Number	:	617-435-9070
Fax Number	:

Provider Business Practice Location Address
First Line	:	1755 THE EXCHANGE SE STE 360D
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-7404
Country	:	US
Telephone Number	:	617-435-9070
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MERDICE CUMBERBATCH
Credential	:	RN
Telephone Number	:	470-552-8502

Provider Enumeration Date	:	09/16/2019
Last Update Date	:	03/05/2020

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