Healthcare Provider Details

I. General information

NPI: 1245473792
Provider Name (Legal Business Name): S. HEALTH CORPORATION OF ELLIJAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1362 S MAIN ST
ELLIJAY GA
30540-5410
US

IV. Provider business mailing address

PO BOX 2239
ELLIJAY GA
30540-0025
US

V. Phone/Fax

Practice location:
  • Phone: 706-276-4741
  • Fax: 706-276-4645
Mailing address:
  • Phone: 706-276-4741
  • Fax: 706-276-4645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number10611232
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBBIE SELF
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CFO
Phone: 706-276-4741