Healthcare Provider Details

I. General information

NPI: 1669032405
Provider Name (Legal Business Name): GEORGIA-LINA CARE MANAGEMENT,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 EDGEFIELD RD STE B
BELVEDERE SC
29841-1942
US

IV. Provider business mailing address

528 EDGEFIELD RD STE B
BELVEDERE SC
29841-1942
US

V. Phone/Fax

Practice location:
  • Phone: 803-426-8071
  • Fax: 803-426-8144
Mailing address:
  • Phone: 803-426-8071
  • Fax: 806-426-8144

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: MRS. MARTRINO DENISE GODLEY
Title or Position: OWNER
Credential: RN
Phone: 803-426-8071