Provider Demographics
NPI:1588613434
Name:ARCHBOLD HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:ARCHBOLD HEALTH SERVICES, INC.
Other - Org Name:VNA OF SOUTHWEST GA
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:229-246-6462
Mailing Address - Street 1:PO BOX 3197
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31799-3197
Mailing Address - Country:US
Mailing Address - Phone:229-246-6462
Mailing Address - Fax:229-246-9959
Practice Address - Street 1:117 S DONALSON ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39817-5901
Practice Address - Country:US
Practice Address - Phone:229-246-6462
Practice Address - Fax:229-246-9959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043-010251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000166944AMedicaid
GA000166944AMedicaid
GA117040Medicare ID - Type Unspecified