Basic Information
Provider Information | |||||||||
NPI: | 1033184437 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | EFFINGHAM HOSPITAL, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | EFFINGHAM CARE AND REHABILITATION CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 459 HIGHTWAY 119 SOUTH | ||||||||
Address2: | ATTN: ALIA ALLEN/MEDICAL STAFF OFFICE | ||||||||
City: | SPRINGFIELD | ||||||||
State: | GA | ||||||||
PostalCode: | 31329 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9127540175 | ||||||||
FaxNumber: | 9127546395 | ||||||||
Practice Location | |||||||||
Address1: | 459 HWY 119 S | ||||||||
Address2: |   | ||||||||
City: | SPRINGFIELD | ||||||||
State: | GA | ||||||||
PostalCode: | 313293021 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9127540200 | ||||||||
FaxNumber: | 9127541250 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/20/2006 | ||||||||
LastUpdateDate: | 08/16/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | WITT | ||||||||
AuthorizedOfficialFirstName: | FRAN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
AuthorizedOfficialTelephone: | 9127540160 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | DNP, MBA, LNHA, RN | ||||||||
NPICertificationDate: | 08/16/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1-051-315 | GA | Y |   | Nursing & Custodial Care Facilities | Skilled Nursing Facility |   |
ID Information
ID | Type | State | Issuer | Description | 000140907A | 05 | GA |   | MEDICAID |