Provider Demographics
NPI:1861630543
Name:ETERNAL HOPE HOSPICE
Entity Type:Organization
Organization Name:ETERNAL HOPE HOSPICE
Other - Org Name:ETERNAL HOPE HOSPICE LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-229-4373
Mailing Address - Street 1:123 N 18TH STREET
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-2264
Mailing Address - Country:US
Mailing Address - Phone:770-229-4673
Mailing Address - Fax:678-603-1624
Practice Address - Street 1:123 N 18TH STREET
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-2264
Practice Address - Country:US
Practice Address - Phone:770-229-4673
Practice Address - Fax:678-603-1624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA984261040AMedicaid