Provider Demographics
NPI:1366485161
Name:HANCOCK COUNTY HEALTH CARE LLC
Entity Type:Organization
Organization Name:HANCOCK COUNTY HEALTH CARE LLC
Other - Org Name:PROVIDENCE OF SPARTA HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ARNETRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PROSSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-444-5153
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:GA
Mailing Address - Zip Code:31087-0086
Mailing Address - Country:US
Mailing Address - Phone:706-444-5153
Mailing Address - Fax:706-444-8875
Practice Address - Street 1:60 PROVIDENCE ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:GA
Practice Address - Zip Code:31087-1601
Practice Address - Country:US
Practice Address - Phone:706-444-5153
Practice Address - Fax:706-444-8875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-070-1881314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00142623AMedicaid
115397Medicare Oscar/Certification