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General NPI Number Information
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NPI Number | 1083915524
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Entity Type | Organization
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Legal Business Name | SCREVEN COUNTY HOSPITAL LLC
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 215 MIMS RD
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City | SYLVANIA
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State | GA
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Zip | 30467-1994
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Country | US
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Telephone | 912-564-7426
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Fax | 912-564-0010
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Provider Business Mailing Address
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Address Line | 460 MALL BLVD STE B
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City | SAVANNAH
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State | GA
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Zip | 31406-4891
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Country | US
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Telephone | 912-644-5300
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Fax | 912-644-5260
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Authorized Official
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Title or Position | CEO
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Name | DAVID ALEX VILLA
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Credential |
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Telephone | 760-468-7765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | 124-164
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License Number State | GA
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