Provider Demographics
NPI:1194028688
Name:HEARTLITE HOSPICE ELLIJAY, INC.
Entity Type:Organization
Organization Name:HEARTLITE HOSPICE ELLIJAY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DANEKAS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:630-942-0100
Mailing Address - Street 1:800 W. ROOSEVELT ROAD
Mailing Address - Street 2:SUITE C-206
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5851
Mailing Address - Country:US
Mailing Address - Phone:630-942-0100
Mailing Address - Fax:256-532-2398
Practice Address - Street 1:163 DALTON STREET
Practice Address - Street 2:
Practice Address - City:EAST ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540
Practice Address - Country:US
Practice Address - Phone:706-635-7001
Practice Address - Fax:706-635-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061-0343-H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based