Provider Demographics
NPI:1396730792
Name:SPANISH OAKS HOSPICE INC
Entity type:Organization
Organization Name:SPANISH OAKS HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:F
Authorized Official - Last Name:MUNGER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:912-356-0233
Mailing Address - Street 1:8510 WHITFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-6137
Mailing Address - Country:US
Mailing Address - Phone:912-336-0233
Mailing Address - Fax:912-356-0193
Practice Address - Street 1:8510 WHITFIELD AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-6137
Practice Address - Country:US
Practice Address - Phone:912-336-0233
Practice Address - Fax:912-356-0193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025180H315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111601Medicare ID - Type Unspecified