Provider Demographics
NPI:1619135464
Name:SOUTHEAST GEORGIA HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:SOUTHEAST GEORGIA HEALTH SYSTEM, INC.
Other - Org Name:SOUTHEAST GEORGIA HEALTH SYSTEM - SENIOR CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MA
Authorized Official - Phone:912-466-7049
Mailing Address - Street 1:2415 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4722
Mailing Address - Country:US
Mailing Address - Phone:912-466-7000
Mailing Address - Fax:912-466-7026
Practice Address - Street 1:2611 WILDWOOD DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4250
Practice Address - Country:US
Practice Address - Phone:912-265-8528
Practice Address - Fax:912-466-7026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-063-1918314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000830827AMedicaid
GA115721Medicare Oscar/Certification