Organization
LEGACY HOSPICE GA, LLC
Active
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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