MEDICARE: WILLOWBROOK HOSPICE 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	:	1992355796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOWBROOK HOSPICE LLC

Provider Business Mailing Address
First Line	:	162 W MAIN ST STE 306
Second Line	:
City	:	CARTERSVILLE
State	:	GA
Zip	:	30120-3565
Country	:	US
Telephone Number	:	470-315-4728
Fax Number	:	470-315-4844

Provider Business Practice Location Address
First Line	:	162 W MAIN ST STE 306
Second Line	:
City	:	CARTERSVILLE
State	:	GA
Zip	:	30120-3573
Country	:	US
Telephone Number	:	470-315-4728
Fax Number	:	470-315-4844

Authorized Official
Title or Position	:	EXEC DIRECTOR
Name	:	STEPHANIE DUBOSE
Credential	:
Telephone Number	:	470-315-4728

Provider Enumeration Date	:	09/13/2019
Last Update Date	:	04/02/2024

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