Provider Demographics
NPI:1700402443
Name:ANGEL HEART HOSPICE, LLC
Entity Type:Organization
Organization Name:ANGEL HEART HOSPICE, LLC
Other - Org Name:FAMILY HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-419-9200
Mailing Address - Street 1:4562 FORSYTH RD STE 4
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-0510
Mailing Address - Country:US
Mailing Address - Phone:800-410-4663
Mailing Address - Fax:706-807-6941
Practice Address - Street 1:1225 JOHNSON FERRY RD STE 855
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2774
Practice Address - Country:US
Practice Address - Phone:423-541-1993
Practice Address - Fax:423-553-1829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-18
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based