1013005784 NPI number — WARE VISITING NURSES SERVICE, INC

Table of content: (NPI 1013005784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013005784 NPI number — WARE VISITING NURSES SERVICE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WARE VISITING NURSES SERVICE, 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:
1013005784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1484
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAYCROSS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31502-1484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-330-7394
Provider Business Mailing Address Fax Number:
912-330-7399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
138 CANAL ST
Provider Second Line Business Practice Location Address:
SUITE 505
Provider Business Practice Location Address City Name:
POOLER
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31322-4051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-330-7394
Provider Business Practice Location Address Fax Number:
912-330-7399
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
PEARSON
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
912-283-1262

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  013-295-H , 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: 029946378F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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