Provider Demographics
NPI:1578121414
Name:ENNOBLE HOSPICE GA LLC
Entity Type:Organization
Organization Name:ENNOBLE HOSPICE GA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KUSHABHADRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-821-9010
Mailing Address - Street 1:2 UNIVERSITY PLZ STE 204
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6211
Mailing Address - Country:US
Mailing Address - Phone:201-564-0142
Mailing Address - Fax:
Practice Address - Street 1:50 GLENLAKE PKWY STE 420
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-3489
Practice Address - Country:US
Practice Address - Phone:404-595-2210
Practice Address - Fax:404-465-3580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based