Provider Demographics
NPI:1023385093
Name:CITIZEN HEALTHCARE, LLC
Entity Type:Organization
Organization Name:CITIZEN HEALTHCARE, LLC
Other - Org Name:CITIZEN HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PRAKASH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOPALAKRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-366-6539
Mailing Address - Street 1:1861 PEELER RD
Mailing Address - Street 2:STE 200
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5714
Mailing Address - Country:US
Mailing Address - Phone:479-366-6539
Mailing Address - Fax:
Practice Address - Street 1:1861 PEELER RD
Practice Address - Street 2:STE 200
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-5714
Practice Address - Country:US
Practice Address - Phone:479-366-6539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044-0367-H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based