MEDICARE: HILLCREST 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	031131H	GA

General Provider Information

NPI Number	:	1639130065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILLCREST HOSPICE, INC.

Provider Business Mailing Address
First Line	:	1800 PHOENIX BLVD
Second Line	:	SUITE 128
City	:	ATLANTA
State	:	GA
Zip	:	30349-5593
Country	:	US
Telephone Number	:	678-284-5850
Fax Number	:	770-909-3406

Provider Business Practice Location Address
First Line	:	1335 LAKE RIDGE PKWY
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30296-3393
Country	:	US
Telephone Number	:	770-994-6569
Fax Number	:	770-994-3757

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANITA HOSSFELD
Credential	:	LMSW
Telephone Number	:	678-284-5856

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	08/22/2020

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