SACRED JOURNEY HOSPICE LLC NPI 1306919683

NPI Information

NPI: 1306919683
Provider Name: SACRED JOURNEY HOSPICE, LLC

Former Legal Business Name: SACRED JOURNEY HOSPICE, INC.

Classification: Hospice Care, Community Based - 251G00000X
Entity Type: Organization

Address:
138 PEACH DR
MCDONOUGH, GA
ZIP 30253
Phone: (678) 583-0717
Get Directions

SACRED JOURNEY HOSPICE, LLC is a hospice care community based in Mcdonough, GA. SACRED JOURNEY HOSPICE, LLC NPI is 1306919683. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Sacred Journey Hospice, Inc..

The provider's business location address is:

138 PEACH DR
MCDONOUGH, GA
ZIP 30253
Phone: (678) 583-0717
Fax: (678) 583-0712

The provider's authorized official is Timothy Whobrey .
The authorized official title is Provider Enrollment and has the following contact phone number (502) 630-7249.

The CLIA number assigned to this NPI record is 11D2144495 - hospice with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/16/2006 and was last updated on 8/10/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	315D00000X	Hospice, Inpatient		075176H	GEORGIA	No
2	251G00000X	Hospice Care, Community Based		075176H	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	054652053A	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »