Provider Demographics
NPI:1841017985
Name:BLUE SUMMIT PALLIATIVE CARE LLC
Entity type:Organization
Organization Name:BLUE SUMMIT PALLIATIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELPOZO MCKISSICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-395-2510
Mailing Address - Street 1:11113 HOUZE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1495
Mailing Address - Country:US
Mailing Address - Phone:470-395-2510
Mailing Address - Fax:
Practice Address - Street 1:11113 HOUZE RD STE 150
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1495
Practice Address - Country:US
Practice Address - Phone:470-395-2510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUE SUMMIT HOLDING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty