Organization
MT BERRY HOSPICE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE WEST (CFO)
(770) 907-7222
Entity
Organization
Contact information
Practice address
4300 MARTHA BERRY HWY NE, ROME, GA 30165-8642
(706) 232-1571
(706) 232-1572
Mailing address
4300 MARTHA BERRY HWY NE, ROME, GA 30165-8642
(706) 232-1571
(706) 232-1572
Taxonomy
Speciality
Code
Description
License number
State
315D00000X
Inpatient Hospice
Primary
036-0347-H
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11-1714
MEDICARE PTAN
GA
Enumeration date
11/26/2013
Last updated
11/26/2013
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