Provider Demographics
NPI:1316481716
Name:HOSPICE ADVANTAGE, LLC
Entity type:Organization
Organization Name:HOSPICE ADVANTAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-309-5668
Mailing Address - Street 1:100 CRESCENT CENTER PKWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-7060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3535 SATELLITE BLVD STE 290
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4646
Practice Address - Country:US
Practice Address - Phone:770-449-8142
Practice Address - Fax:770-449-8143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
202G700665Medicare Oscar/Certification