Provider Demographics
NPI:1124861414
Name:METANOIA HOSPICE AND PALLIATIVE CARE LLC
Entity type:Organization
Organization Name:METANOIA HOSPICE AND PALLIATIVE CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:KADZAKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-528-0577
Mailing Address - Street 1:1244 BEAVER RUIN RD STE 205
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3266
Mailing Address - Country:US
Mailing Address - Phone:678-887-3388
Mailing Address - Fax:678-904-6845
Practice Address - Street 1:1244 BEAVER RUIN RD STE 205
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3266
Practice Address - Country:US
Practice Address - Phone:678-528-0577
Practice Address - Fax:678-904-6845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based