Provider Demographics
NPI:1235594912
Name:JOURNEY HOSPICE CARE OF ATLANTA LLC
Entity Type:Organization
Organization Name:JOURNEY HOSPICE CARE OF ATLANTA LLC
Other - Org Name:JOURNEY HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:RICE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:770-608-5225
Mailing Address - Street 1:4800 ASHFORD DUNWOODY RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4897
Mailing Address - Country:US
Mailing Address - Phone:404-254-2454
Mailing Address - Fax:404-256-2455
Practice Address - Street 1:4800 ASHFORD DUNWOODY RD
Practice Address - Street 2:SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-4897
Practice Address - Country:US
Practice Address - Phone:404-254-2454
Practice Address - Fax:404-256-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
111647Medicare Oscar/Certification