- Enrollment id
- O20210303002093
- Enrollment state
- GA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1902496722
- Multiple npi flag
- N
- Ccn
- 851543
- Associate id
- 8123434891
- Organization name
- GEORGIA COMMUNITY HOSPICE LLC
- Incorporation date
- 2020-03-09
- Incorporation state
- GA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 245 COUNTRY CLUB DR
- Address line 2
- BLDG 100C
- City
- STOCKBRIDGE
- State
- GA
- Zip code
- 302817216