Provider Demographics
NPI:1578624185
Name:THE HOSPITAL AUTHORITY OF HABERSHAM COUNTY
Entity Type:Organization
Organization Name:THE HOSPITAL AUTHORITY OF HABERSHAM COUNTY
Other - Org Name:HMC HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-754-3113
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-0668
Mailing Address - Country:US
Mailing Address - Phone:706-754-6575
Mailing Address - Fax:706-754-8750
Practice Address - Street 1:157 ADAMS DR
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-4564
Practice Address - Country:US
Practice Address - Phone:706-754-6575
Practice Address - Fax:706-754-8750
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HOSPITAL AUTHORITY OF HABERSHAM COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-13
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA068-191251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000740165AMedicaid
GA21397OtherWELLCARE
GA21397OtherWELLCARE