Provider Demographics
NPI:1427114768
Name:LIVING CARE HOSPICE, LLC
Entity type:Organization
Organization Name:LIVING CARE HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KERRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-739-4990
Mailing Address - Street 1:215 S DUVAL ST
Mailing Address - Street 2:
Mailing Address - City:CLAXTON
Mailing Address - State:GA
Mailing Address - Zip Code:30417-2031
Mailing Address - Country:US
Mailing Address - Phone:912-739-4990
Mailing Address - Fax:912-739-4933
Practice Address - Street 1:215 S DUVAL ST
Practice Address - Street 2:
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417-2031
Practice Address - Country:US
Practice Address - Phone:912-739-4990
Practice Address - Fax:912-739-4933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA132-168-H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000927396AMedicaid
GA000927396AMedicaid
GA111595Medicare Oscar/Certification