Provider Demographics
NPI:1669745006
Name:TAPESTRY HOSPICE OF MCDONOUGH,LLC
Entity type:Organization
Organization Name:TAPESTRY HOSPICE OF MCDONOUGH,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:NALL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:678-672-8470
Mailing Address - Street 1:1335 MCDONOUGH PKWY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7072
Mailing Address - Country:US
Mailing Address - Phone:770-692-5115
Mailing Address - Fax:770-692-5101
Practice Address - Street 1:1335 MCDONOUGH PKWY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-7072
Practice Address - Country:US
Practice Address - Phone:770-692-5115
Practice Address - Fax:770-692-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based