Organization
COUNTRYSIDE HOSPICE CARE INC
Active
Organization
COUNTRYSIDE HOSPICE CARE INC
Active
Other names
SolAmor Hospice Sharpsburg
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GLEN CAVALLO (SR. VP - OPERATIONS)
(479) 996-5900
Entity
Organization
Contact information
Practice address
820 EBENEZER CHURCH RD, SUITE 106, SHARPSBURG, GA 30277-2073
(770) 252-4999
(770) 252-4743
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
—
00894132A
—
GA
01
—
038156H
GEORGIA HOSPICE LICENSE
GA
Enumeration date
06/03/2006
Last updated
02/16/2012
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