Provider Demographics
NPI:1922536382
Name:GEORGIA PALLIATIVE CARE INC.
Entity Type:Organization
Organization Name:GEORGIA PALLIATIVE CARE INC.
Other - Org Name:SOLACE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:CHPCA
Authorized Official - Phone:912-454-8166
Mailing Address - Street 1:PO BOX 180
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30475-0180
Mailing Address - Country:US
Mailing Address - Phone:912-454-8166
Mailing Address - Fax:912-454-8168
Practice Address - Street 1:101 MCINTOSH ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-3106
Practice Address - Country:US
Practice Address - Phone:912-454-8166
Practice Address - Fax:912-454-8168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA138-0448-H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based