Provider Demographics
NPI:1457675373
Name:ORCHID PERSONAL CARE HOME
Entity Type:Organization
Organization Name:ORCHID PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-507-0142
Mailing Address - Street 1:7661 KAYNE BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-2545
Mailing Address - Country:US
Mailing Address - Phone:706-507-0142
Mailing Address - Fax:706-507-2374
Practice Address - Street 1:7661 KAYNE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-2545
Practice Address - Country:US
Practice Address - Phone:706-507-0142
Practice Address - Fax:706-507-2374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA109-01-167-1310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA223468425AMedicaid