Healthcare Provider Details

I. General information

NPI: 1598844235
Provider Name (Legal Business Name): GINGERHILL ALTERNATIVE LIVING SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 GEORGE C WILSON DR SUITE A
AUGUSTA GA
30909-4502
US

IV. Provider business mailing address

1203 GEORGE C WILSON DR SUITE A
AUGUSTA GA
30909-4502
US

V. Phone/Fax

Practice location:
  • Phone: 706-869-8400
  • Fax:
Mailing address:
  • Phone: 706-869-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGIE D TALKINGTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 706-869-8400