Basic Information
| Provider Information | |||||||||
| NPI: | 1861743080 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIFE CHOICE HOSPICE OF GEORGIA II LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 CADILLAC DR | ||||||||
| Address2: | SUITE 360 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153777022 | ||||||||
| FaxNumber: | 6153734457 | ||||||||
| Practice Location | |||||||||
| Address1: | 1585 HIGHWAY 34 E | ||||||||
| Address2: | SUITE A | ||||||||
| City: | NEWNAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302652401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882553097 | ||||||||
| FaxNumber: | 7702524743 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2012 | ||||||||
| LastUpdateDate: | 11/02/2015 | ||||||||
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| AuthorizedOfficialLastName: | JAMES | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6154255418 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
No ID Information.