Provider Demographics
NPI:1952499808
Name:CAHABA HOSPICE, INC.
Entity Type:Organization
Organization Name:CAHABA HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-418-0566
Mailing Address - Street 1:410 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-4514
Mailing Address - Country:US
Mailing Address - Phone:334-418-0566
Mailing Address - Fax:334-418-0570
Practice Address - Street 1:410 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-4514
Practice Address - Country:US
Practice Address - Phone:334-418-0566
Practice Address - Fax:334-418-0570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11646251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL011-678OtherBCBS PROVIDER NUMBER
ALPIC1549EMedicaid
AL011-678OtherBCBS PROVIDER NUMBER