Provider Demographics
NPI:1013402353
Name:HOSPICE SERVICES OF GA, LLC
Entity Type:Organization
Organization Name:HOSPICE SERVICES OF GA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-834-8196
Mailing Address - Street 1:3744 WALTON WAY EXT STE C
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0917
Mailing Address - Country:US
Mailing Address - Phone:706-364-1933
Mailing Address - Fax:706-364-1933
Practice Address - Street 1:3744 WALTON WAY EXT STE C
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-0917
Practice Address - Country:US
Practice Address - Phone:706-364-1933
Practice Address - Fax:706-364-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA121-0453-H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003218799AMedicaid
GA121-0453-HOtherSTATE HOSPICE LICENSE