Provider Demographics
NPI:1487650917
Name:ISLAND HEALTH CARE INC
Entity Type:Organization
Organization Name:ISLAND HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BOLCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-629-2727
Mailing Address - Street 1:4 SKIDAWAY VILLAGE WALK STE A
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31411-2962
Mailing Address - Country:US
Mailing Address - Phone:912-629-2727
Mailing Address - Fax:912-234-1718
Practice Address - Street 1:4 SKIDAWAY VILLAGE WALK STE A
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31411-2962
Practice Address - Country:US
Practice Address - Phone:912-629-2727
Practice Address - Fax:912-234-1718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025236H251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00817308AMedicaid
GA117002Medicare ID - Type Unspecified