Basic Information
| Provider Information | |||||||||
| NPI: | 1659310514 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOSPICE PREFERRED CHOICE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 FIANNA WAY | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729199008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778238375 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1117 PERIMETER CENTER WEST | ||||||||
| Address2: | N500 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303385451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706988785 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 10/12/2017 | ||||||||
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| AuthorizedOfficialLastName: | RASMUSSEN-JONES | ||||||||
| AuthorizedOfficialFirstName: | HOLLY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 4792014835 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HOMECARE PREFERRED CHOICE, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | MCD00779358A | 05 | GA | MEDICAID |