Provider Demographics
NPI:1336811504
Name:GEORGIA-LINA HOME CARE
Entity Type:Organization
Organization Name:GEORGIA-LINA HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTRINO
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:GODLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:706-373-4454
Mailing Address - Street 1:120 FLOYD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-4276
Mailing Address - Country:US
Mailing Address - Phone:803-426-8071
Mailing Address - Fax:803-426-8144
Practice Address - Street 1:120 FLOYD AVE
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-4276
Practice Address - Country:US
Practice Address - Phone:803-426-8071
Practice Address - Fax:803-426-8144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX1823Medicaid