1043287303 NPI number — CHATUGE REGIONAL HOSPITAL INC

Table of content: (NPI 1043287303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043287303 NPI number — CHATUGE REGIONAL HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHATUGE REGIONAL HOSPITAL 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:
CHATUGE REGIONAL NURSING HOME
Provider Other Organization Name Type Code:
3
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:
1043287303
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
386 BEL AIRE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIAWASSEE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30546-3313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-896-2231
Provider Business Mailing Address Fax Number:
706-896-7584

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
386 BEL AIRE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIAWASSEE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30546-3313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-896-2231
Provider Business Practice Location Address Fax Number:
706-896-7584
Provider Enumeration Date:
03/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SELF
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
706-439-6812

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  11391595 , 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: 000143338A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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