MEDICARE: GINGERHILL ALTERNATIVE LIVING SERVICE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1598844235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GINGERHILL ALTERNATIVE LIVING SERVICE, INC

Provider Business Mailing Address
First Line	:	1203 GEORGE C WILSON DR
Second Line	:	SUITE A
City	:	AUGUSTA
State	:	GA
Zip	:	30909-4502
Country	:	US
Telephone Number	:	706-869-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1203 GEORGE C WILSON DR
Second Line	:	SUITE A
City	:	AUGUSTA
State	:	GA
Zip	:	30909-4502
Country	:	US
Telephone Number	:	706-869-8400
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	ANGIE D TALKINGTON
Credential	:
Telephone Number	:	706-869-8400

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	08/22/2020

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