Provider Demographics
NPI:1952686768
Name:TAPESTRY HOSPICE OF NORTHWEST GEORGIA LLC
Entity Type:Organization
Organization Name:TAPESTRY HOSPICE OF NORTHWEST GEORGIA LLC
Other - Org Name:TAPESTRY HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:NALL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:706-383-8812
Mailing Address - Street 1:2950 CHEROKEE ST NW STE 900
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6505
Mailing Address - Country:US
Mailing Address - Phone:706-383-8812
Mailing Address - Fax:706-383-8853
Practice Address - Street 1:189 PROFESSIONAL CT SE STE 300
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-7064
Practice Address - Country:US
Practice Address - Phone:706-383-8812
Practice Address - Fax:706-383-8853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community BasedGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003137033AMedicaid