Basic Information
| Provider Information | |||||||||
| NPI: | 1851605695 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEARTLITE HOSPICE CARE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 583 HIGHLAND XING STE 100 | ||||||||
| Address2: | |||||||||
| City: | EAST ELLIJAY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305406402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066357001 | ||||||||
| FaxNumber: | 7066357003 | ||||||||
| Practice Location | |||||||||
| Address1: | 583 HIGHLAND XING STE 100 | ||||||||
| Address2: | |||||||||
| City: | EAST ELLIJAY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305406402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066357001 | ||||||||
| FaxNumber: | 7066357003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2010 | ||||||||
| LastUpdateDate: | 08/04/2010 | ||||||||
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| AuthorizedOfficialLastName: | HOPKINS | ||||||||
| AuthorizedOfficialFirstName: | M. | ||||||||
| AuthorizedOfficialMiddleName: | B. | ||||||||
| AuthorizedOfficialTitleorPosition: | VP FOR CLINICAL AFFAIRS | ||||||||
| AuthorizedOfficialTelephone: | 7068475700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HEARTLITE HOSPICE CARE, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | BSN, RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 061-0343-H | GA | Y | Agencies | Hospice Care, Community Based |
No ID Information.