Provider Demographics
NPI:1376181289
Name:MITCHELL HEALTHCARE, LLC
Entity Type:Organization
Organization Name:MITCHELL HEALTHCARE, LLC
Other - Org Name:INTERIM HEALTHCARE OF AUGUSTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CUTTER
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-550-1107
Mailing Address - Street 1:801 BROAD ST STE 605
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-1252
Mailing Address - Country:US
Mailing Address - Phone:706-550-1107
Mailing Address - Fax:706-955-9318
Practice Address - Street 1:801 BROAD ST STE 605
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1252
Practice Address - Country:US
Practice Address - Phone:706-550-1107
Practice Address - Fax:706-955-9318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHCP010361OtherPRIVATE HOME CARE PROVIDER LICENSE, GEORGIA DEPARTMENT OF COMMUNITY HEALTH
GA003234083AMedicaid
GA003234236AMedicaid