Provider Demographics
NPI:1578727707
Name:TWELVE OAKS HOSPICE, INC.
Entity Type:Organization
Organization Name:TWELVE OAKS HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-922-2386
Mailing Address - Street 1:580 W CROSSVILLE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-7505
Mailing Address - Country:US
Mailing Address - Phone:770-922-2386
Mailing Address - Fax:
Practice Address - Street 1:580 W CROSSVILLE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-7505
Practice Address - Country:US
Practice Address - Phone:770-922-2386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003111518AMedicaid
GA111689Medicare Oscar/Certification