Provider Demographics
NPI:1336163815
Name:EMBRACING HOSPICECARE, LLC
Entity type:Organization
Organization Name:EMBRACING HOSPICECARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICH
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-493-6745
Mailing Address - Street 1:50 N LAURA ST
Mailing Address - Street 2:STE 1800
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-3664
Mailing Address - Country:US
Mailing Address - Phone:904-493-6745
Mailing Address - Fax:904-262-4804
Practice Address - Street 1:5775 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:STE D 580
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1556
Practice Address - Country:US
Practice Address - Phone:404-659-0110
Practice Address - Fax:770-454-7730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044162H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00890557AMedicaid
GA00890557AMedicaid