MEDICARE: PRIMECARE HOSPICE & PALLIATIVE 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

General Provider Information

NPI Number	:	1427597350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMECARE HOSPICE & PALLIATIVE INC

Provider Business Mailing Address
First Line	:	1735 IRWINTON RD STE 1A
Second Line	:
City	:	MILLEDGEVILLE
State	:	GA
Zip	:	31061-3830
Country	:	US
Telephone Number	:	770-755-1972
Fax Number	:	478-451-0224

Provider Business Practice Location Address
First Line	:	1735 IRWINTON RD STE 1A
Second Line	:
City	:	MILLEDGEVILLE
State	:	GA
Zip	:	31061-3830
Country	:	US
Telephone Number	:	770-755-1972
Fax Number	:	478-451-0224

Authorized Official
Title or Position	:	COO
Name	:	CALEB FLOURNOY
Credential	:
Telephone Number	:	770-755-1972

Provider Enumeration Date	:	02/12/2017
Last Update Date	:	07/02/2023

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