Provider Demographics
NPI:1568733632
Name:SANZIE HEALTHCARE SERVICES, INC
Entity Type:Organization
Organization Name:SANZIE HEALTHCARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:I
Authorized Official - Last Name:AGAZIE RN BSN CMSRN
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN CMSRN
Authorized Official - Phone:770-716-2233
Mailing Address - Street 1:115 BRADFORD SQ STE B
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-1962
Mailing Address - Country:US
Mailing Address - Phone:770-716-2333
Mailing Address - Fax:844-270-7142
Practice Address - Street 1:115 BRADFORD SQ STE B
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-1962
Practice Address - Country:US
Practice Address - Phone:770-716-2333
Practice Address - Fax:844-270-7142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-22
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACLAA001000251C00000X, 251S00000X, 261QD1600X
GA031R0903251E00000X
251E00000X
GA031-R-0903251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003133865AMedicaid
GA003133861BMedicaid
GA003133861DMedicaid
GA003133861AMedicaid
GA003133861CMedicaid