MEDICARE: WESTSIDE HOSPICE & 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	315D00000X	Inpatient Hospice
2	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1457066573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTSIDE HOSPICE & PALLIATIVE CARE, LLC

Provider Business Mailing Address
First Line	:	5990 LOVE ST
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30168-4029
Country	:	US
Telephone Number	:	678-353-8528
Fax Number	:

Provider Business Practice Location Address
First Line	:	5990 LOVE ST
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30168-4029
Country	:	US
Telephone Number	:	678-353-8528
Fax Number	:

Authorized Official
Title or Position	:	ORGANIZER & MANAGER
Name	:	ANITA PRINCE
Credential	:	NP
Telephone Number	:	678-353-8528

Provider Enumeration Date	:	01/23/2023
Last Update Date	:	01/23/2023

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