Provider Demographics
NPI:1720972524
Name:GRATEFUL HOSPICE LLC
Entity type:Organization
Organization Name:GRATEFUL HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:SMITH JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:678-592-4183
Mailing Address - Street 1:6340 ROBINS NEST
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-4976
Mailing Address - Country:US
Mailing Address - Phone:678-592-4183
Mailing Address - Fax:770-881-7503
Practice Address - Street 1:4500 HUGH HOWELL RD STE 785
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4723
Practice Address - Country:US
Practice Address - Phone:678-592-4183
Practice Address - Fax:470-945-2121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care