1457583718 NPI number — SUNCREST HOME HEALTH OF SOUTH GA, INC.

Table of content: (NPI 1457583718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457583718 NPI number — SUNCREST HOME HEALTH OF SOUTH GA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNCREST HOME HEALTH OF SOUTH GA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457583718
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 N SAINT AUGUSTINE RD STE E&F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALDOSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31601-8471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-242-3509
Provider Business Mailing Address Fax Number:
229-242-3595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 N SAINT AUGUSTINE RD STE E&F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALDOSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31601-8471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-242-3509
Provider Business Practice Location Address Fax Number:
229-242-3595
Provider Enumeration Date:
08/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
TUELLER
Authorized Official First Name:
AMBER
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
208-207-2726

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  037-101 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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