JACKSON LAKE HOSPICE INC (NPI# 1255417432) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255417432 |
| Entity Type | Organization |
| Organization Name | JACKSON LAKE HOSPICE INC |
| Other Organization Name | JACKSON LAKE HOSPICE |
| Practice Address |
128 Brandon Way Macon GA 31210 |
| Mailing Address |
Po Box 1927 Jackson GA 30233-0037 |
| Practice Telephone | 7703059393 |
| Practice Fax Number | 7703059662 |
| Mailing Telephone | 7703059393 |
| Mailing Fax Number | 7703059662 |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. MICHAEL KEITH HENSON (CEO) |
| Authorized Official Telephone | 7703059393 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251G00000X | Hospice Care, Community Based | Agencies |
| Other Name | Type Code |
|---|---|
| Jackson Lake Hospice | Doing Business As Name - Organization |
| Street Address |
128 BRANDON WAY |
| City | MACON |
| State | GA |
| Zip Code | 31210 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396826327 | Home Companions Plus, Inc. | Home Health | 128 Brandon Way, Macon, GA 31210-4226 | 2006-10-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033743455 | Dana Elizabeth Toth | Nurse Practitioner | 5300 Bowman Rd, Macon, GA 31210 | 2020-02-25 |
| 1871124735 | Jessica Bello | Nurse Practitioner | 5300 Bowman Road, Macon, GA 31210 | 2020-01-30 |
| 1225505787 | Rebekah Hollinshead | Occupational Therapist | Therapy Specialists of Georgia, 4116 Arkwright Road, Macon, GA 31210 | 2018-11-01 |
| 1346744943 | Ace Medical Transport LLC. | Ambulance | 728 Gay Dr, Macon, GA 31210 | 2018-03-20 |
| 1972965226 | Omar Faruk Ahmad | Family Medicine | 3400 Riverside Drvie, Macon, GA 31210 | 2016-03-25 |
| 1083074868 | Macon Dentist Office, PC | Dentist | 206 Tom Hill Sr Blvd, Suite 106, Macon, GA 31210 | 2016-03-07 |
| 1992176952 | Kerisia Wasztyl | Marriage & Family Therapist | 4691 Pine Valley Dr, Macon, GA 31210 | 2015-10-15 |
| 1073905444 | Eunice Malave De Leon | Social Worker | 174 Spring St, Macon, GA 31210 | 2015-02-23 |
| 1396141545 | Axis Surgery Center LLC | Clinic/Center | 230 Sheraton Blvd, Ste B, Macon, GA 31210 | 2014-11-17 |
| 1073914115 | Monique Rechelle Delay Moore | Community/Behavioral Health | 646 Millrun Court, Macon, GA 31210 | 2014-09-09 |
| Find all providers in zip 31210 | ||||
| Taxonomy Code | 251G00000X |
| Grouping | Agencies |
| Classification | Hospice Care, Community Based |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376093534 | Compassus Op of Georgia II LLC | Hospice Care, Community Based | 1100 Northside Drive, Macon, GA 31210-2280 | 2016-10-11 |
| 1316317993 | 4front Healthcare of Middle Georgia, LLC | Hospice Care, Community Based | 682 1st St, Macon, GA 31201 | 2015-09-25 |
| 1609210491 | Caresouth Hospice, LLC | Hospice Care, Community Based | 1760 Bass Rd Ste 202, Macon, GA 31210 | 2013-04-23 |
| 1003934795 | Ideal Home Care of Ga | Hospice Care, Community Based | 182 Riley Ave Ste F2, Macon, GA 31204-0778 | 2007-03-27 |
| 1609900364 | Optum Palliative and Hospice Care, Inc | Hospice Care, Community Based | 4875 Riverside Dr Ste 104, Macon, GA 31210-1149 | 2007-03-15 |
| 1760557953 | The Medical Center of Central Georgia Inc. | Hospice Care, Community Based | 6261 Peake Road, Macon, GA 31210-8074 | 2006-11-22 |
| 1659319630 | Southerncare, Inc. | Hospice Care, Community Based | 5233 Riverside Drive, Suite E, Macon, GA 31210-1253 | 2006-06-03 |
| 1235177205 | Pruitthealth Hospice, Inc. | Hospice Care, Community Based | 6060 Lakeside Commons Dr, Macon, GA 31210-5778 | 2006-06-03 |
| 1912968355 | Hillcrest Hospice, Inc | Hospice Care, Community Based | 115 Arkwright Lndg, Macon, GA 31210-1364 | 2006-03-28 |
| 1639177397 | Hospice Care Options Inc | Hospice Care, Community Based | 486 New St, Macon, GA 31201 | 2005-07-07 |
| Find all providers in MACON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.