Provider Demographics
NPI:1285648568
Name:PUBLIC HEALTH HOME HEALTH, INC.
Entity Type:Organization
Organization Name:PUBLIC HEALTH HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:RETTERBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:229-253-1067
Mailing Address - Street 1:PO BOX 3284
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31604-3284
Mailing Address - Country:US
Mailing Address - Phone:229-253-1242
Mailing Address - Fax:229-253-1151
Practice Address - Street 1:1811 GREEN CIR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2734
Practice Address - Country:US
Practice Address - Phone:229-253-1242
Practice Address - Fax:229-253-1151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA092-207251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00056845IMedicaid
GA00056845BMedicaid
GA00056845AMedicaid
GA00056845BMedicaid