Provider Demographics
NPI:1053477877
Name:STATEWIDE HEALTHCARE, INC.
Entity Type:Organization
Organization Name:STATEWIDE HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:J. CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-231-8958
Mailing Address - Street 1:714 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUIT 100
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-5570
Mailing Address - Country:US
Mailing Address - Phone:912-231-8958
Mailing Address - Fax:
Practice Address - Street 1:714 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUIT 100
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-5570
Practice Address - Country:US
Practice Address - Phone:912-231-8958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA621610311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home