Provider Demographics
NPI:1073694683
Name:CHRISTIAN MINISTRIES HOSPICE, INC
Entity Type:Organization
Organization Name:CHRISTIAN MINISTRIES HOSPICE, INC
Other - Org Name:CHRISTIAN MINISTRIES HOSPICE OF RIVERDALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ODOM
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:770-227-9222
Mailing Address - Street 1:121 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224
Mailing Address - Country:US
Mailing Address - Phone:770-227-9222
Mailing Address - Fax:770-227-9009
Practice Address - Street 1:125 HIGHWAY 138 SW
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-4007
Practice Address - Country:US
Practice Address - Phone:678-833-3750
Practice Address - Fax:678-833-3755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031-224H251G00000X
GA031-224-H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000802931BMedicaid
GA00802931BMedicaid
GA00802931BMedicaid