Provider Demographics
NPI:1407811060
Name:WELLSTAR COMMUNITY HOSPICE, LLC
Entity Type:Organization
Organization Name:WELLSTAR COMMUNITY HOSPICE, LLC
Other - Org Name:WELLSTAR COMMUNITY HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACTING PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUDZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-792-7600
Mailing Address - Street 1:4040 HOSPITAL WEST DR
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8117
Mailing Address - Country:US
Mailing Address - Phone:770-732-6710
Mailing Address - Fax:770-732-6732
Practice Address - Street 1:4040 HOSPITAL WEST DR
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8117
Practice Address - Country:US
Practice Address - Phone:770-732-6710
Practice Address - Fax:770-732-6732
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLSTAR HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-18
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033077H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000373799AMedicaid
GA111507Medicare ID - Type UnspecifiedHOSPICE