Provider Demographics
NPI:1275836082
Name:ST. JOSEPH HOSPICE, LLC
Entity Type:Organization
Organization Name:ST. JOSEPH HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-922-7480
Mailing Address - Street 1:1231 AUGUSTA WEST PKWY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-1807
Mailing Address - Country:US
Mailing Address - Phone:706-922-7480
Mailing Address - Fax:706-364-3285
Practice Address - Street 1:1231 AUGUSTA WEST PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1807
Practice Address - Country:US
Practice Address - Phone:706-922-7480
Practice Address - Fax:706-364-3285
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREFERRED HOSPICE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-16
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPPLIED FOR251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCHSP136Medicaid
GA003126081AMedicaid
GA=========OtherTRICARE
GA=========OtherTRICARE
GA111722Medicare PIN