Basic Information
| Provider Information | |||||||||
| NPI: | 1912968355 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HILLCREST HOSPICE, INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | PORTSBRIDGE HOSPICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 PHOENIX BLVD | ||||||||
| Address2: | SUITE 128 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303495593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6782845850 | ||||||||
| FaxNumber: | 7709093406 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 ARKWRIGHT LNDG | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312101364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4783140150 | ||||||||
| FaxNumber: | 4787570717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HOSSFELD | ||||||||
| AuthorizedOfficialFirstName: | ANITA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6782845856 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 011183H | GA | Y | Agencies | Hospice Care, Community Based |
No ID Information.