Provider Demographics
NPI:1144770199
Name:SILVERLEAF HOSPICE, INC
Entity Type:Organization
Organization Name:SILVERLEAF HOSPICE, INC
Other - Org Name:BRIDGEWAY PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:RASMUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-932-6302
Mailing Address - Street 1:1395 S MARIETTA PKWY SE
Mailing Address - Street 2:BLDG 400 SUITE 116
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4440
Mailing Address - Country:US
Mailing Address - Phone:678-932-6302
Mailing Address - Fax:678-402-5246
Practice Address - Street 1:1731 MERIWEATHER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7746
Practice Address - Country:US
Practice Address - Phone:706-546-0286
Practice Address - Fax:706-546-0289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA108-0297-H207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty