Provider Demographics
NPI:1568169183
Name:BLUE SUMMIT HOSPICE OF NORTH GEORGIA LLC
Entity Type:Organization
Organization Name:BLUE SUMMIT HOSPICE OF NORTH GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELPOZO MCKISSICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-386-5578
Mailing Address - Street 1:1445 WOODMONT LN NW # 511
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2866
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1124 N TENNESSEE STREET
Practice Address - Street 2:SUITE 103, OFFICE 13
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120
Practice Address - Country:US
Practice Address - Phone:470-365-2657
Practice Address - Fax:470-359-5886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based