Organization
LEGACY HOSPICE GA, LLC
Active
Other names
Coastal Hospice of Georgia
Organization subpart
No
Provider details
NPI number
Authorized official
DONNIE MABERRY (EXECUTIVE VICE PRESIDENT)
(972) 468-8070
Entity
Organization
Contact information
Practice address
106 SHOPPERS WAY STE 111, BRUNSWICK, GA 31525-0522
(912) 434-9810
(912) 434-9752
Mailing address
101 W RENNER RD STE 420, RICHARDSON, TX 75082-2022
(806) 771-0588
(806) 687-5966
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003250312A
—
GA
01
—
11D2210199
CLIA
GA
01
—
HSPC001445
STATE OPERATOR'S LICENSE #
GA
Enumeration date
10/28/2020
Last updated
08/05/2024
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