Provider Demographics
NPI:1508605379
Name:NORTH GWINNETT HOSPICE SERVICES, LLC
Entity type:Organization
Organization Name:NORTH GWINNETT HOSPICE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:UDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-390-5587
Mailing Address - Street 1:530 HIGHLAND STATION DR STE 3002
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6576
Mailing Address - Country:US
Mailing Address - Phone:404-390-5587
Mailing Address - Fax:929-564-8690
Practice Address - Street 1:530 HIGHLAND STATION DR STE 3002
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6576
Practice Address - Country:US
Practice Address - Phone:404-390-5587
Practice Address - Fax:929-564-8690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based