Healthcare Provider Details

I. General information

NPI: 1831967371
Provider Name (Legal Business Name): THCH PERSONAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 MILLER STREET EXT
STATESBORO GA
30458-4377
US

IV. Provider business mailing address

660 MILLER STREET EXT
STATESBORO GA
30458-4377
US

V. Phone/Fax

Practice location:
  • Phone: 912-421-2126
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JANET RIVERS
Title or Position: NURSE AIDE
Credential:
Phone: 912-314-7958