MEDICARE: PALLADIUM HOSPICE AND PALLIATIVE CARE, 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	:	1053723734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALLADIUM HOSPICE AND PALLIATIVE CARE, LLC

Provider Business Mailing Address
First Line	:	4210 COLUMBIA RD., BLDG# 5, SUITE A
Second Line	:
City	:	MARTINEZ
State	:	GA
Zip	:	30907-0401
Country	:	US
Telephone Number	:	770-715-9654
Fax Number	:

Provider Business Practice Location Address
First Line	:	4210 COLUMBIA RD., BLDG# 5, SUITE A
Second Line	:
City	:	MARTINEZ
State	:	GA
Zip	:	30907-0401
Country	:	US
Telephone Number	:	770-715-9654
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAWN-MICHELLE TEACHEY
Credential	:
Telephone Number	:	803-767-4837

Provider Enumeration Date	:	05/29/2014
Last Update Date	:	11/28/2016

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