Provider Demographics
NPI:1174098966
Name:ATHC - HOSPICE, LLC
Entity type:Organization
Organization Name:ATHC - HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOEPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-828-2210
Mailing Address - Street 1:131 TEMPLE LAKE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-4903
Mailing Address - Country:US
Mailing Address - Phone:804-520-7766
Mailing Address - Fax:
Practice Address - Street 1:131 TEMPLE LAKE DR STE 2
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-4903
Practice Address - Country:US
Practice Address - Phone:804-520-7766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHC - HOSPICE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-08
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based