MEDICARE: FLINT RIVER HOSPICE, INC

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	096-235-H	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053422535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLINT RIVER HOSPICE, INC

Provider Business Mailing Address
First Line	:	402 N WEST ST
Second Line	:
City	:	BAINBRIDGE
State	:	GA
Zip	:	39817-3678
Country	:	US
Telephone Number	:	229-248-1050
Fax Number	:	229-248-1070

Provider Business Practice Location Address
First Line	:	402 N WEST ST
Second Line	:
City	:	BAINBRIDGE
State	:	GA
Zip	:	39817-3678
Country	:	US
Telephone Number	:	229-248-1050
Fax Number	:	229-248-1070

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	KEVIN MILLER
Credential	:
Telephone Number	:	229-248-1050

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	10/08/2008

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Directions to “FLINT RIVER HOSPICE, INC ” Practice Location

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