Healthcare Provider Details

I. General information

NPI: 1336139070
Provider Name (Legal Business Name): PRESBYTERIAN HOME, QUITMAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W SCREVEN ST
QUITMAN GA
31643-3913
US

IV. Provider business mailing address

PO BOX 407
QUITMAN GA
31643-3913
US

V. Phone/Fax

Practice location:
  • Phone: 229-263-6100
  • Fax: 229-263-6195
Mailing address:
  • Phone: 229-263-6100
  • Fax: 229-263-6151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00142579A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name: DIANNE ARRENDALE
Title or Position: CFO
Credential: CPA
Phone: 229-263-6193