Provider Demographics
NPI:1053422535
Name:FLINT RIVER HOSPICE, INC
Entity type:Organization
Organization Name:FLINT RIVER HOSPICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-248-1050
Mailing Address - Street 1:402 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39817-3678
Mailing Address - Country:US
Mailing Address - Phone:229-248-1050
Mailing Address - Fax:229-248-1070
Practice Address - Street 1:402 N WEST ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39817-3678
Practice Address - Country:US
Practice Address - Phone:229-248-1050
Practice Address - Fax:229-248-1070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA096-235-H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA821692805AMedicaid
GA111630Medicare ID - Type UnspecifiedIN-HOME HOSPICE