Organization Name: | COUNTRYSIDE HOSPICE CARE, INC |
NPI Number: | 1013248814 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GLEN CAVALLO (SR. VP - OPERATIONS) |
Mailing Address: | 203 Oakside Ln Building 203, Suite B Canton |
State: | GA US |
Postal Code: | 301146407 |
Phone Number: | 7707049982 |
Fax Number: | 7707042755 |
NPI Enumeration Date: | 01/19/2010 |
NPI Last Update Date: | 02/16/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251G00000X |
License Number: | 028-0350-H |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Hospice Care, Community Based |
Taxonomy Specialization: | |
Taxonomy Definition: |