Provider Demographics
NPI:1396470720
Name:PRIORITY CARE HOSPICE & PALLIATIVE LLC
Entity type:Organization
Organization Name:PRIORITY CARE HOSPICE & PALLIATIVE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:KADZAKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-887-3388
Mailing Address - Street 1:3355 SWEETWATER RD APT 7308
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-8531
Mailing Address - Country:US
Mailing Address - Phone:678-201-1252
Mailing Address - Fax:
Practice Address - Street 1:3355 SWEETWATER RD APT 7308
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-8531
Practice Address - Country:US
Practice Address - Phone:678-201-1252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based