Provider Demographics
NPI:1023174919
Name:HEART OF GEORGIA HOSPICE , INC
Entity type:Organization
Organization Name:HEART OF GEORGIA HOSPICE , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-953-5161
Mailing Address - Street 1:103 WESTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8111
Mailing Address - Country:US
Mailing Address - Phone:478-953-5161
Mailing Address - Fax:478-953-5232
Practice Address - Street 1:103 WESTRIDGE DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8111
Practice Address - Country:US
Practice Address - Phone:478-953-5161
Practice Address - Fax:478-953-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00372512AMedicaid
GA00372512AMedicaid