Healthcare Provider Details

I. General information

NPI: 1003813577
Provider Name (Legal Business Name): OGEECHEE AREA HOSPICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 DONEHOO ST
STATESBORO GA
30458
US

IV. Provider business mailing address

200 DONEHOO ST
STATESBORO GA
30458
US

V. Phone/Fax

Practice location:
  • Phone: 912-764-8441
  • Fax: 912-489-8247
Mailing address:
  • Phone: 912-764-8441
  • Fax: 912-489-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number016057H
License Number StateGA

VIII. Authorized Official

Name: MRS. VANESSA RAMIREZ
Title or Position: EXECUTIVE DIRECTOR
Credential: RN, MSN
Phone: 912-764-8441