Organization
COUNTRYSIDE HOSPICE CARE, INC
Active
Other names
SolAmor Hospice Stockbridge
Organization subpart
No
Provider details
NPI number
Authorized official
GLEN CAVALLO (SR. VP - OPERATIONS)
(479) 996-5900
Entity
Organization
Contact information
Practice address
245 COUNTRY CLUB DR, BLDG. 300A, STOCKBRIDGE, GA 30281-9080
(256) 231-9190
(256) 231-2350
Mailing address
101 SUN AVE NE, ALBUQUERQUE, NM 87109-4373
(505) 468-5604
(505) 468-4681
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
038156H
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000894132A
—
GA
01
—
038156H
GEORGIA HOSPICE LICENSE
GA
Enumeration date
01/26/2011
Last updated
02/16/2012
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