Provider Demographics
NPI:1982723201
Name:CALLE VINAS, INC.
Entity Type:Organization
Organization Name:CALLE VINAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:SELPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-923-8508
Mailing Address - Street 1:312 N DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3350
Mailing Address - Country:US
Mailing Address - Phone:478-923-8508
Mailing Address - Fax:888-278-9704
Practice Address - Street 1:312 N DAVIS DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3350
Practice Address - Country:US
Practice Address - Phone:478-923-8508
Practice Address - Fax:888-278-9704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00887224AMedicaid