Provider Demographics
NPI:1033417001
Name:ATHC - HOSPICE, LLC
Entity Type:Organization
Organization Name:ATHC - HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSING & LEGAL PROJECTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-400-0887
Mailing Address - Street 1:8149 WALNUT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4517
Mailing Address - Country:US
Mailing Address - Phone:804-358-3480
Mailing Address - Fax:804-612-3713
Practice Address - Street 1:8149 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-4517
Practice Address - Country:US
Practice Address - Phone:804-358-3840
Practice Address - Fax:804-612-3713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X
VAHSP-11179251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHSP-12179OtherVA STATE HOSPICE LICENSE
VAHSP-12179OtherVA STATE HOSPICE LICENSE
VA497493Medicare UPIN
VA497600Medicare UPIN