Provider Demographics
NPI:1407274723
Name:HESTIA HOSPICE & FAMILY CARE LLC
Entity Type:Organization
Organization Name:HESTIA HOSPICE & FAMILY CARE LLC
Other - Org Name:BROOKDALE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER, REGULATORY PRACTICES
Authorized Official - Prefix:
Authorized Official - First Name:DONNIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-278-0367
Mailing Address - Street 1:1 PARK PLZ
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-6527
Mailing Address - Country:US
Mailing Address - Phone:615-344-9551
Mailing Address - Fax:
Practice Address - Street 1:25 WOODS LAKE RD
Practice Address - Street 2:STE 405
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6125
Practice Address - Country:US
Practice Address - Phone:864-370-7218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH AT HOME-BHS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-03
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHPC0181251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
421627Medicare Oscar/Certification