Provider Demographics
NPI:1396624979
Name:MARMALADE PALLATIVE HEALTH LLC
Entity type:Organization
Organization Name:MARMALADE PALLATIVE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:PETRY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:770-464-5858
Mailing Address - Street 1:215 AZALEA CT
Mailing Address - Street 2:
Mailing Address - City:SOCIAL CIRCLE
Mailing Address - State:GA
Mailing Address - Zip Code:30025-5037
Mailing Address - Country:US
Mailing Address - Phone:770-464-5858
Mailing Address - Fax:
Practice Address - Street 1:215 AZALEA CT
Practice Address - Street 2:
Practice Address - City:SOCIAL CIRCLE
Practice Address - State:GA
Practice Address - Zip Code:30025-5037
Practice Address - Country:US
Practice Address - Phone:770-464-5858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-28
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty