Provider Demographics
NPI:1265035513
Name:AEON HOSPICE LLC
Entity Type:Organization
Organization Name:AEON HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:PRAKASH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOPALAKRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-462-1339
Mailing Address - Street 1:11205 ALPHARETTA HWY STE E3
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5646
Mailing Address - Country:US
Mailing Address - Phone:678-462-1339
Mailing Address - Fax:
Practice Address - Street 1:11205 ALPHARETTA HWY STE E3
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5646
Practice Address - Country:US
Practice Address - Phone:678-462-1339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based