Provider Demographics
NPI:1821641457
Name:AT HOME PALLIATIVE CARE, LLC
Entity Type:Organization
Organization Name:AT HOME PALLIATIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:GARDENHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-923-1203
Mailing Address - Street 1:3331 ANNA RUBY LANE
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519
Mailing Address - Country:US
Mailing Address - Phone:678-923-1203
Mailing Address - Fax:
Practice Address - Street 1:114 ENTERPRISE CT
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904
Practice Address - Country:US
Practice Address - Phone:706-507-3482
Practice Address - Fax:706-507-3488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care