Provider Demographics
NPI:1700427861
Name:SUNCARE HOSPICE LLC
Entity Type:Organization
Organization Name:SUNCARE HOSPICE LLC
Other - Org Name:SUNCARE HOSPICE AND PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERTZOG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-800-9288
Mailing Address - Street 1:804 TOWNE PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-5154
Mailing Address - Country:US
Mailing Address - Phone:912-800-9288
Mailing Address - Fax:912-800-9238
Practice Address - Street 1:804 TOWNE PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5154
Practice Address - Country:US
Practice Address - Phone:888-887-8674
Practice Address - Fax:888-887-8674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community Based
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003233089AMedicaid