- Enrollment id
- O20140520000112
- Enrollment state
- GA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1396169074
- Multiple npi flag
- N
- Ccn
- 111754
- Associate id
- 6406079466
- Organization name
- MAGNOLIA HOSPICE, LLC
- Doing business as name
- OPUSCARE OF GEORGIA
- Incorporation date
- 2013-11-07
- Incorporation state
- GA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 5040 SNAPFINGER WOODS DR
- Address line 2
- STE 204A
- City
- STONECREST
- State
- GA
- Zip code
- 300354020