Provider Demographics
NPI:1881755940
Name:VISITING NURSES ASSOC OF TELFAIR CO. INC
Entity type:Organization
Organization Name:VISITING NURSES ASSOC OF TELFAIR CO. INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:V
Authorized Official - Last Name:ERTZBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:ADM
Authorized Official - Phone:229-868-6422
Mailing Address - Street 1:1650 S THIRD AVE.
Mailing Address - Street 2:P.O. BOX 253
Mailing Address - City:MCRAE
Mailing Address - State:GA
Mailing Address - Zip Code:31055-0253
Mailing Address - Country:US
Mailing Address - Phone:229-868-6422
Mailing Address - Fax:229-868-2471
Practice Address - Street 1:1650 S THIRD AVE.
Practice Address - Street 2:
Practice Address - City:MCRAE
Practice Address - State:GA
Practice Address - Zip Code:31055-0253
Practice Address - Country:US
Practice Address - Phone:229-868-6422
Practice Address - Fax:229-868-2471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA134-073251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00190033AMedicaid
GA00190033AMedicaid