Provider Demographics
NPI:1033456892
Name:HOME CONVALESCENT CARE
Entity Type:Organization
Organization Name:HOME CONVALESCENT CARE
Other - Org Name:HOME CONVALESCENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:229-254-4967
Mailing Address - Street 1:140 BUD HARRELL RD
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39817-7920
Mailing Address - Country:US
Mailing Address - Phone:229-254-4967
Mailing Address - Fax:229-416-4267
Practice Address - Street 1:140 BUD HARRELL RD
Practice Address - Street 2:140 BUD HARRELLE RD,
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39817-7920
Practice Address - Country:US
Practice Address - Phone:229-254-4967
Practice Address - Fax:229-416-4267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-13
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA110296385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child