Provider Demographics
NPI:1982994307
Name:STATEWIDE HEALTHCARE INC.
Entity Type:Organization
Organization Name:STATEWIDE HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-231-8958
Mailing Address - Street 1:102 OGLETHORPE PROFESSIONAL CT
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3600
Mailing Address - Country:US
Mailing Address - Phone:912-231-8958
Mailing Address - Fax:912-234-7701
Practice Address - Street 1:102 OGLETHORPE PROFESSIONAL CT
Practice Address - Street 2:SUITE 4
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3600
Practice Address - Country:US
Practice Address - Phone:912-231-8958
Practice Address - Fax:912-234-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC123456789Medicaid