Provider Demographics
NPI:1114056934
Name:FOUR COUNTY HEALTH CARE, LLC
Entity Type:Organization
Organization Name:FOUR COUNTY HEALTH CARE, LLC
Other - Org Name:FOUR COUNTY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCIAL REPORTING
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEFFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-621-2100
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31825-0339
Mailing Address - Country:US
Mailing Address - Phone:229-887-2021
Mailing Address - Fax:229-887-3978
Practice Address - Street 1:99 OVERBY DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:GA
Practice Address - Zip Code:31825-1322
Practice Address - Country:US
Practice Address - Phone:229-887-2021
Practice Address - Fax:229-887-3978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-128-1712261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care