Organization
GLORY HOSPICE & PALLIATIVE CARE COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN EUGENE GARDENHIRE (OWNER)
(706) 507-5445
Entity
Organization
Contact information
Practice address
122 ENTERPRISE CT, SUITE D, COLUMBUS, GA 31904-3651
(706) 507-5445
(706) 507-5488
Mailing address
122 ENTERPRISE CT, SUITE D, COLUMBUS, GA 31904-3651
(706) 507-5445
(706) 507-5488
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111715
MEDICARE PROVIDER NUMBER
GA
Enumeration date
12/07/2010
Last updated
08/31/2012
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