Provider Demographics
NPI:1336139070
Name:PRESBYTERIAN HOME, QUITMAN, INC.
Entity Type:Organization
Organization Name:PRESBYTERIAN HOME, QUITMAN, INC.
Other - Org Name:PRESBYTERIAN HOME, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARRENDALE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:229-263-6193
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31643-3913
Mailing Address - Country:US
Mailing Address - Phone:229-263-6100
Mailing Address - Fax:229-263-6151
Practice Address - Street 1:1901 W SCREVEN ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:GA
Practice Address - Zip Code:31643-3913
Practice Address - Country:US
Practice Address - Phone:229-263-6100
Practice Address - Fax:229-263-6195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00142579AMedicaid
GA115498Medicare Oscar/Certification
GA00142579AMedicaid