Provider Demographics
NPI:1275595415
Name:HERITAGE HOSPICE INC
Entity Type:Organization
Organization Name:HERITAGE HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:R
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-423-5959
Mailing Address - Street 1:1290 KENNESTONE CIRCLE
Mailing Address - Street 2:SUITE A-213
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6009
Mailing Address - Country:US
Mailing Address - Phone:770-423-5959
Mailing Address - Fax:770-423-5944
Practice Address - Street 1:1290 KENNESTONE CIRCLE
Practice Address - Street 2:SUITE A-213
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-6009
Practice Address - Country:US
Practice Address - Phone:770-423-5959
Practice Address - Fax:770-423-5944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111614Medicare Oscar/Certification