| Organization Name: | PROVIDENCE HOSPICE, INC. |
| NPI Number: | 1720150212 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | IAN K. ASH (CHIEF EXECUTIVE OFFICE) |
| Mailing Address: | 100 Corporate Center Drive Lower Level Stockbridge |
| State: | GA US |
| Postal Code: | 302817244 |
| Phone Number: | 6782849385 |
| Fax Number: | 6782849391 |
| NPI Enumeration Date: | 11/14/2006 |
| NPI Last Update Date: | 12/03/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | 075-0253-H |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |