Provider Demographics
NPI:1851605695
Name:HEARTLITE HOSPICE CARE, INC
Entity Type:Organization
Organization Name:HEARTLITE HOSPICE CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FOR CLINICAL AFFAIRS
Authorized Official - Prefix:MR
Authorized Official - First Name:M.
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:706-847-5700
Mailing Address - Street 1:583 HIGHLAND XING STE 100
Mailing Address - Street 2:
Mailing Address - City:EAST ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-6402
Mailing Address - Country:US
Mailing Address - Phone:706-635-7001
Mailing Address - Fax:706-635-7003
Practice Address - Street 1:583 HIGHLAND XING STE 100
Practice Address - Street 2:
Practice Address - City:EAST ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-6402
Practice Address - Country:US
Practice Address - Phone:706-635-7001
Practice Address - Fax:706-635-7003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLITE HOSPICE CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061-0343-H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based