Provider Demographics
NPI:1023575032
Name:LAKESIDE HOSPICE INC.
Entity Type:Organization
Organization Name:LAKESIDE HOSPICE INC.
Other - Org Name:WOODSTOCK HOSPICE CARE FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-884-1111
Mailing Address - Street 1:4010 MASTERS RD
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35128-7550
Mailing Address - Country:US
Mailing Address - Phone:052-884-1111
Mailing Address - Fax:205-884-1114
Practice Address - Street 1:409 E 10TH ST STE 200
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4781
Practice Address - Country:US
Practice Address - Phone:256-541-5696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKESIDE HOSPICE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-26
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient