Provider Demographics
NPI:1932157450
Name:UNIVERSITY HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:UNIVERSITY HEALTH SERVICES, INC.
Other - Org Name:UNIVERSITY HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC VP/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-722-9011
Mailing Address - Street 1:4106 COLUMBIA RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-1450
Mailing Address - Country:US
Mailing Address - Phone:706-868-3220
Mailing Address - Fax:706-868-3221
Practice Address - Street 1:4106 COLUMBIA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-1450
Practice Address - Country:US
Practice Address - Phone:706-868-3220
Practice Address - Fax:706-868-3221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036-R-0002251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00926934AMedicaid