Provider Demographics
NPI:1073555256
Name:ADVENTIST HEALTH SYSTEM GEORGIA, INC.
Entity Type:Organization
Organization Name:ADVENTIST HEALTH SYSTEM GEORGIA, INC.
Other - Org Name:GORDON HOME CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SELF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-879-4710
Mailing Address - Street 1:PO BOX 12938
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703-7013
Mailing Address - Country:US
Mailing Address - Phone:706-629-3333
Mailing Address - Fax:706-625-9083
Practice Address - Street 1:105 WILLOWBROOK WAY SE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-1404
Practice Address - Country:US
Practice Address - Phone:706-629-3333
Practice Address - Fax:706-625-9083
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVENTIST HEALTH SYSTEM GEORGIA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-12
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA164-188251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00788554AMedicaid
GA117106OtherACORDIA NATIONAL
GA00788554AMedicaid
GA117106OtherHUMANA INS GOLD CHC MCR
GA117106OtherUNITED HEALTHCARE
GA117106OtherUNITED HEALTHCARE