Basic Information
| Provider Information | |||||||||
| NPI: | 1316481716 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOSPICE ADVANTAGE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 CRESCENT CENTER PKWY | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | TUCKER | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300847060 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3535 SATELLITE BLVD STE 290 | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300964646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704498142 | ||||||||
| FaxNumber: | 7704498143 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2016 | ||||||||
| LastUpdateDate: | 12/11/2020 | ||||||||
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| AuthorizedOfficialLastName: | ADKINS | ||||||||
| AuthorizedOfficialFirstName: | RUSSELL | ||||||||
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| AuthorizedOfficialTitleorPosition: | SVP CHIEF LEGAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6153095668 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
No ID Information.