Provider Demographics
NPI:1013005784
Name:WARE VISITING NURSES SERVICE, INC
Entity Type:Organization
Organization Name:WARE VISITING NURSES SERVICE, INC
Other - Org Name:CHARLTON VISITING NURSES GREATER SAVANNAH AREA SUBUNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PEARSON
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-283-1262
Mailing Address - Street 1:PO BOX 1484
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31502-1484
Mailing Address - Country:US
Mailing Address - Phone:912-330-7394
Mailing Address - Fax:912-330-7399
Practice Address - Street 1:138 CANAL ST
Practice Address - Street 2:SUITE 505
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4051
Practice Address - Country:US
Practice Address - Phone:912-330-7394
Practice Address - Fax:912-330-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013-295-H251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA029946378FMedicaid
GA117150Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
GA117150Medicare Oscar/Certification