Provider Demographics
NPI:1225068901
Name:THREE RIVERS HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:THREE RIVERS HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:478-374-3468
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-0640
Mailing Address - Country:US
Mailing Address - Phone:478-374-3468
Mailing Address - Fax:478-374-6741
Practice Address - Street 1:115 NW MAIN ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-3103
Practice Address - Country:US
Practice Address - Phone:912-537-9192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA140-234-H251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00186766FMedicaid
GA00821026AMedicaid
GA00821026AMedicaid