Provider Demographics
NPI:1427206960
Name:LONGLEAF HOSPICE, LLC
Entity Type:Organization
Organization Name:LONGLEAF HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-939-9179
Mailing Address - Street 1:2310 PARKLAKE DR NE STE 325
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2915
Mailing Address - Country:US
Mailing Address - Phone:770-939-9179
Mailing Address - Fax:770-621-3083
Practice Address - Street 1:2310 PARKLAKE DR NE STE 325
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2915
Practice Address - Country:US
Practice Address - Phone:770-939-9179
Practice Address - Fax:770-621-3083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0440301H251G00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based