Healthcare Provider Details

I. General information

NPI: 1518956481
Provider Name (Legal Business Name): JASPER HEALTH SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

898 COLLEGE ST
MONTICELLO GA
31064-1261
US

IV. Provider business mailing address

898 COLLEGE ST
MONTICELLO GA
31064-1261
US

V. Phone/Fax

Practice location:
  • Phone: 706-468-8826
  • Fax: 706-468-2253
Mailing address:
  • Phone: 706-468-8826
  • Fax: 706-468-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10791614
License Number StateGA

VIII. Authorized Official

Name: MRS. DONNA D HOLMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 706-468-8826