Provider Demographics
NPI:1912622549
Name:BLUE SUMMIT HOSPICE AND PALLIATIVE CARE OF ROSWELL LLC
Entity Type:Organization
Organization Name:BLUE SUMMIT HOSPICE AND PALLIATIVE CARE OF ROSWELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELPOZO MCKISSICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-386-5578
Mailing Address - Street 1:1137 ALPHARETTA ST STE C
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3603
Mailing Address - Country:US
Mailing Address - Phone:470-395-2510
Mailing Address - Fax:470-359-5886
Practice Address - Street 1:1137 ALPHARETTA ST STE C
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3603
Practice Address - Country:US
Practice Address - Phone:470-395-2510
Practice Address - Fax:470-359-5886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based