Provider Demographics
NPI:1053723734
Name:PALLADIUM HOSPICE AND PALLIATIVE CARE, LLC
Entity type:Organization
Organization Name:PALLADIUM HOSPICE AND PALLIATIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAWN-MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEACHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-767-4837
Mailing Address - Street 1:4210 COLUMBIA RD., BLDG# 5, SUITE A
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0401
Mailing Address - Country:US
Mailing Address - Phone:770-715-9654
Mailing Address - Fax:
Practice Address - Street 1:4210 COLUMBIA RD., BLDG# 5, SUITE A
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-0401
Practice Address - Country:US
Practice Address - Phone:770-715-9654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORIANNA INVESTMENT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-29
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
111767Medicare Oscar/Certification