WELLSTAR COMMUNITY HOSPICE LLC NPI 1407811060

NPI Information

NPI: 1407811060
Provider Name: WELLSTAR COMMUNITY HOSPICE, LLC

Doing Business As: WELLSTAR COMMUNITY HOSPICE

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

CLIA Number: 11D2029372

Address:
4040 HOSPITAL WEST DR
AUSTELL, GA
ZIP 30106
Phone: (770) 732-6710
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WELLSTAR COMMUNITY HOSPICE, LLC is a hospice care community based in Austell, GA. WELLSTAR COMMUNITY HOSPICE, LLC NPI is 1407811060. The provider is registered as an organization entity type.
The provider Is Doing Business As Wellstar Community Hospice.

The provider's business location address is:

4040 HOSPITAL WEST DR
AUSTELL, GA
ZIP 30106-117
Phone: (770) 732-6710
Fax: (770) 732-6732

The provider's authorized official is Anthony J Budzinski .
The authorized official title is Acting President & Ceo and has the following contact phone number (770) 792-7600.

The CLIA number assigned to this NPI record is 11D2029372 - hospice with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/18/2006 and was last updated on 1/31/2011.

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	251G00000X	Hospice Care, Community Based		033077H	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	111507	MEDICARE ID-TYPE UNSPECIFIED	GEORGIA	HOSPICE
2	000373799A	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

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