Provider Demographics
NPI:1366993230
Name:HOMESTEAD HOSPICE OF CAHABA
Entity type:Organization
Organization Name:HOMESTEAD HOSPICE OF CAHABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAHLEGA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDSHARAFAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-456-3531
Mailing Address - Street 1:10888 CRABAPPLE RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075
Mailing Address - Country:US
Mailing Address - Phone:678-966-0077
Mailing Address - Fax:678-387-3716
Practice Address - Street 1:3005 CITIZENS PARKWAY
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701
Practice Address - Country:US
Practice Address - Phone:334-418-0566
Practice Address - Fax:334-418-0570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALE2401315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL011549Medicare PIN