Basic Information
| Provider Information | |||||||||
| NPI: | 1316933088 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHATTAHOOCHEE VALLEY HOSPITAL SOCIETY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LANIER HOME HEALTH SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1806 44TH ST | ||||||||
| Address2: | |||||||||
| City: | VALLEY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 368543441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347561950 | ||||||||
| FaxNumber: | 3347561970 | ||||||||
| Practice Location | |||||||||
| Address1: | 1806 44TH ST | ||||||||
| Address2: | |||||||||
| City: | VALLEY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 368543441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347561950 | ||||||||
| FaxNumber: | 3347561970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | VEAL | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF HOME HEALTH | ||||||||
| AuthorizedOfficialTelephone: | 3347561950 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | AL | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 51043280 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER | LAN7123A | 05 | AL | MEDICAID |