Provider Demographics
NPI:1568465110
Name:CHATTAHOOCHEE VALLEY HOSPITAL SOCIETY
Entity Type:Organization
Organization Name:CHATTAHOOCHEE VALLEY HOSPITAL SOCIETY
Other - Org Name:GEORGE H. LANIER MEMORIAL NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEWBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-756-1401
Mailing Address - Street 1:4800 48TH ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-3666
Mailing Address - Country:US
Mailing Address - Phone:334-756-1436
Mailing Address - Fax:334-756-9192
Practice Address - Street 1:4800 48TH ST
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3666
Practice Address - Country:US
Practice Address - Phone:334-756-1436
Practice Address - Fax:334-756-9192
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHATTAHOOCHEE VALLEY HOSPITAL SOCIETY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-27
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10323314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4754820SMedicaid
AL4754820SMedicaid
AL015045Medicare UPIN