Provider Demographics
NPI:1053458190
Name:UNADILLA HEALTH CARE CENTER INC
Entity Type:Organization
Organization Name:UNADILLA HEALTH CARE CENTER INC
Other - Org Name:UNAHEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LANCASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-627-3263
Mailing Address - Street 1:2858 PINE STREET
Mailing Address - Street 2:
Mailing Address - City:UNADILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31091
Mailing Address - Country:US
Mailing Address - Phone:478-627-3263
Mailing Address - Fax:478-627-9714
Practice Address - Street 1:2858 PINE STREET
Practice Address - Street 2:
Practice Address - City:UNADILLA
Practice Address - State:GA
Practice Address - Zip Code:31091
Practice Address - Country:US
Practice Address - Phone:478-627-3263
Practice Address - Fax:478-627-9714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0112301223G0001X
GADN0130431223G0001X
GA030206207Q00000X
251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111888Medicare ID - Type Unspecified