Provider Demographics
NPI:1235530338
Name:HOMESTEAD HOSPICE OF SOUTHERN ALABAMA, LLC
Entity Type:Organization
Organization Name:HOMESTEAD HOSPICE OF SOUTHERN ALABAMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAHLEGA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDSHAARAFAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-966-0077
Mailing Address - Street 1:10888 CRABAPPLE ROAD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075
Mailing Address - Country:US
Mailing Address - Phone:678-966-0077
Mailing Address - Fax:770-441-3086
Practice Address - Street 1:104 CARMELLIA AVE, SUITE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037
Practice Address - Country:US
Practice Address - Phone:334-371-2450
Practice Address - Fax:334-371-2455
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREATIVE HOSPICE CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-08
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALE1803251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based