Provider Demographics
NPI:1962499038
Name:IRWIN COUNTY HOSPITAL
Entity Type:Organization
Organization Name:IRWIN COUNTY HOSPITAL
Other - Org Name:PALEMON GASKINS MEMORIAL NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SPIVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-468-3849
Mailing Address - Street 1:201 W DISMUKE AVE
Mailing Address - Street 2:
Mailing Address - City:OCILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31774-1217
Mailing Address - Country:US
Mailing Address - Phone:229-468-3890
Mailing Address - Fax:229-468-3973
Practice Address - Street 1:201 W DISMUKE AVE
Practice Address - Street 2:
Practice Address - City:OCILLA
Practice Address - State:GA
Practice Address - Zip Code:31774-1217
Practice Address - Country:US
Practice Address - Phone:229-468-3890
Practice Address - Fax:229-468-3973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11-A544314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00142326AMedicaid
GA11-A544OtherSTATE OF GA FACILITY ID #
GA115713Medicare Oscar/Certification