Provider Demographics
NPI:1700193836
Name:ALTUSCARE HOSPICE, INC.
Entity Type:Organization
Organization Name:ALTUSCARE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:
Authorized Official - First Name:DREW
Authorized Official - Middle Name:FORD
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-730-8405
Mailing Address - Street 1:1 DUNWOODY PARK
Mailing Address - Street 2:SUITE 128
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-7404
Mailing Address - Country:US
Mailing Address - Phone:770-730-8405
Mailing Address - Fax:770-730-8408
Practice Address - Street 1:151 N BAY VIEW DR
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-5144
Practice Address - Country:US
Practice Address - Phone:770-456-4643
Practice Address - Fax:770-456-4085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022-0324-H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherEMPLOYER IDENTIFICATION NUMBER