Provider Demographics
NPI:1558375840
Name:COLQUITT REGIONAL HEALTH INCORPORATED
Entity Type:Organization
Organization Name:COLQUITT REGIONAL HEALTH INCORPORATED
Other - Org Name:COLQUITT REGIONAL HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-985-3420
Mailing Address - Street 1:2516 5TH AVE SE
Mailing Address - Street 2:PO BOX 3548
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31788-6207
Mailing Address - Country:US
Mailing Address - Phone:229-891-2128
Mailing Address - Fax:229-890-3483
Practice Address - Street 1:2516 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31788-6207
Practice Address - Country:US
Practice Address - Phone:229-891-2128
Practice Address - Fax:229-890-3483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035-160251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000174435FMedicaid
GA000174435AMedicaid
GA000174435BMedicaid
GA000174435DMedicaid
GA117044Medicare Oscar/Certification