Provider Demographics
NPI:1386075927
Name:HOMESTEAD HOSPICE OF SOUTHWEST ALABAMA, LLC
Entity type:Organization
Organization Name:HOMESTEAD HOSPICE OF SOUTHWEST ALABAMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-825-6550
Mailing Address - Street 1:10888 CRABAPPLE RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-5850
Mailing Address - Country:US
Mailing Address - Phone:678-966-0077
Mailing Address - Fax:678-367-3718
Practice Address - Street 1:13456 CHOCTAW AVE
Practice Address - Street 2:
Practice Address - City:GILBERTOWN
Practice Address - State:AL
Practice Address - Zip Code:36908-9502
Practice Address - Country:US
Practice Address - Phone:251-843-3151
Practice Address - Fax:251-843-3158
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREATIVE HOSPICE HOLDING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-09
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALE1205251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL158932Medicaid
AL011672Medicare Oscar/Certification