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Organization
HIAWATHA PRIVATE HEALTHCARE SERVICE, LLC
Active
Organization
HIAWATHA PRIVATE HEALTHCARE SERVICE, LLC
Active
Other names
Hiawatha Private Healthcare Service, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MS. HIAWATHA VENNESSA RAINEY CNA (ADMINISTRATOR)
(706) 306-0091
Entity
Organization
Contact information
Practice address
3424 KENSINGTON DR S, AUGUSTA, GA 30906-6002
(706) 306-0091
(706) 796-0261
Mailing address
3424 KENSINGTON DR S, AUGUSTA, GA 30906-6002
(706) 306-0091
(706) 796-0261
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
251E00000X
PRIVATE HOME CARE PROVIDER
GA
01
—
251J00000X
PRIVATE HOME CARE PROVIDER
GA
01
—
251X00000X
PRIVATE HOME CARE PROVIDER
GA
01
—
253Z00000X
PRIVATE HOME CARE PROVIDER
GA
Enumeration date
11/09/2021
Last updated
06/20/2024
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