Provider Demographics
NPI:1184834749
Name:ADVENTA HOSPICE, INC.
Entity Type:Organization
Organization Name:ADVENTA HOSPICE, INC.
Other - Org Name:AMEDISYS HOSPICE OF BLUE RIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-292-2031
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-298-3548
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:140 PROGRESS CIRCLE
Practice Address - Street 2:SUITE 3
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-4474
Practice Address - Country:US
Practice Address - Phone:706-632-3940
Practice Address - Fax:706-632-3948
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVENTA HOSPICE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-23
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000921962BMedicaid