Organization
SOUTHEAST HOSPICE, LLC,
Active
Other names
Southeast Hospice
Organization subpart
No
Provider details
NPI number
Authorized official
STUART PRATHER (ADMINISTRATOR)
(706) 364-3108
Entity
Organization
Contact information
Practice address
1203 GEORGE C. WILSON DRIVE SUITE A, AUGUSTA, GA 30909-4502
(706) 364-3108
(706) 364-3315
Mailing address
1203 GEORGE C. WILSON DRIVE SUITE A, AUGUSTA, GA 30909-4502
(706) 364-3108
(706) 364-3315
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
121-0416-H
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
121-0416-H
GA HOSPICE LICENSE
GA
Enumeration date
06/08/2015
Last updated
02/10/2017
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