1972597847 NPI number — GLASCOCK COUNTY HEALTH CARE LLC

Table of content: (NPI 1972597847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972597847 NPI number — GLASCOCK COUNTY HEALTH CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLASCOCK COUNTY HEALTH CARE LLC
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:
1972597847
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
434 BEALL SPRINGS ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GIBSON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-598-5301
Provider Business Mailing Address Fax Number:
706-598-3802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
434 BEALL SPRINGS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GIBSON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30810-4224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-598-3201
Provider Business Practice Location Address Fax Number:
706-598-3802
Provider Enumeration Date:
09/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MAJOR
Authorized Official First Name:
PATRELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
706-598-3201

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1-062-1049 , 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)

  • Identifier: 000141116A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com