Provider Demographics
NPI:1760454631
Name:CHATTAHOOCHEE HOSPICE INC
Entity Type:Organization
Organization Name:CHATTAHOOCHEE HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAYE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-756-8043
Mailing Address - Street 1:6 MEDICAL PARK NORTH
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854
Mailing Address - Country:US
Mailing Address - Phone:334-756-8043
Mailing Address - Fax:334-756-8059
Practice Address - Street 1:6 MEDICAL PARK NORTH
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854
Practice Address - Country:US
Practice Address - Phone:334-756-8043
Practice Address - Fax:334-756-8059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10193251G00000X
GA000-107H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPIC1524EMedicaid
AL010484OtherBC/BS OF AL
AL010484OtherBC/BS OF AL