Provider Demographics
NPI:1568627289
Name:THE HOSPICE OF THE SOUTH, LLC
Entity Type:Organization
Organization Name:THE HOSPICE OF THE SOUTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SHROUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-798-2987
Mailing Address - Street 1:PO BOX 805
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-0805
Mailing Address - Country:US
Mailing Address - Phone:229-928-4142
Mailing Address - Fax:229-928-4108
Practice Address - Street 1:206 REES ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3753
Practice Address - Country:US
Practice Address - Phone:229-928-4142
Practice Address - Fax:229-928-4108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1290306H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1290306HMedicaid
GA1290306HMedicaid