Provider Demographics
NPI:1063193738
Name:APPALACHIAN HOSPICE SOUTH LLC
Entity type:Organization
Organization Name:APPALACHIAN HOSPICE SOUTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:RASMUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-331-4354
Mailing Address - Street 1:12 SAMMY MCGHEE BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-7712
Mailing Address - Country:US
Mailing Address - Phone:706-253-4015
Mailing Address - Fax:706-253-4021
Practice Address - Street 1:12 SAMMY MCGHEE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-7712
Practice Address - Country:US
Practice Address - Phone:706-253-4015
Practice Address - Fax:706-253-4021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based