Provider Demographics
NPI:1710975206
Name:DONALSONVILLE HOSPITAL, INC
Entity Type:Organization
Organization Name:DONALSONVILLE HOSPITAL, INC
Other - Org Name:D/B/A SEMINOLE MANOR NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:ORRICK
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:229-524-5217
Mailing Address - Street 1:102 HOSPITAL CIR
Mailing Address - Street 2:
Mailing Address - City:DONALSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:39845-1100
Mailing Address - Country:US
Mailing Address - Phone:229-524-5217
Mailing Address - Fax:229-524-6038
Practice Address - Street 1:100 HOSPITAL CIR
Practice Address - Street 2:
Practice Address - City:DONALSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:39845-1100
Practice Address - Country:US
Practice Address - Phone:229-524-5217
Practice Address - Fax:229-524-6038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA115712OtherTPAN
GA00142909Medicaid