Provider Demographics
NPI:1598145112
Name:ADVENTIST HOMECARE AND MEDICAL SERVICES
Entity Type:Organization
Organization Name:ADVENTIST HOMECARE AND MEDICAL SERVICES
Other - Org Name:ADVENTIST HOMECARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:OHANAJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-273-4100
Mailing Address - Street 1:PO BOX 4881
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4881
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1129 N 5TH STREET EXT
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-3776
Practice Address - Country:US
Practice Address - Phone:229-273-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA156-R-1269253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003159377AMedicaid