Provider Demographics
NPI:1184719171
Name:HOSPICE OF THE PIEDMONT, INC.
Entity type:Organization
Organization Name:HOSPICE OF THE PIEDMONT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-817-5900
Mailing Address - Street 1:675 PETER JEFFERSON PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8618
Mailing Address - Country:US
Mailing Address - Phone:434-817-6900
Mailing Address - Fax:434-245-0302
Practice Address - Street 1:675 PETER JEFFERSON PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8618
Practice Address - Country:US
Practice Address - Phone:434-817-6900
Practice Address - Fax:434-245-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHSP06101251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004915046Medicaid
VA004915046Medicaid