Provider Demographics
NPI:1740368091
Name:COMPASSIONATE CARE HOSPICE OF ATLANTA, LLC
Entity type:Organization
Organization Name:COMPASSIONATE CARE HOSPICE OF ATLANTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:I
Authorized Official - Last Name:GREY
Authorized Official - Suffix:
Authorized Official - Credentials:MPA, RN
Authorized Official - Phone:678-230-4597
Mailing Address - Street 1:261 CONNECTICUT DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-4177
Mailing Address - Country:US
Mailing Address - Phone:609-267-1178
Mailing Address - Fax:609-239-2096
Practice Address - Street 1:4340 GEORGETOWN SQ
Practice Address - Street 2:SUITE 608
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6231
Practice Address - Country:US
Practice Address - Phone:678-230-4597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA956591812Medicaid
GA956591812Medicaid