Provider Demographics
NPI:1124417555
Name:MABLEHOUSE HOSPICE
Entity type:Organization
Organization Name:MABLEHOUSE HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:MIRANDA
Authorized Official - Last Name:JONES-GATES
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN/MGHA
Authorized Official - Phone:770-875-5519
Mailing Address - Street 1:6405 THE TRL
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-4959
Mailing Address - Country:US
Mailing Address - Phone:770-875-5519
Mailing Address - Fax:770-875-5519
Practice Address - Street 1:6405 THE TRL
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-4959
Practice Address - Country:US
Practice Address - Phone:770-875-5519
Practice Address - Fax:770-875-5519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service