# HIAWATHA PRIVATE HEALTHCARE SERVICE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Hiawatha Private Healthcare Service, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285390716
- **Authorized official:** MS. HIAWATHA VENNESSA RAINEY CNA (ADMINISTRATOR)
- **Authorized official phone:** (706) 306-0091

## Contact information

- **Practice address:** 3424 KENSINGTON DR S, AUGUSTA, GA 30906-6002
- **Practice address phone:** (706) 306-0091
- **Practice address fax:** (706) 796-0261
- **Mailing address:** 3424 KENSINGTON DR S, AUGUSTA, GA 30906-6002
- **Mailing address phone:** (706) 306-0091
- **Mailing address fax:** (706) 796-0261

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | — | Yes |

## Other

- **Enumeration date:** 11/09/2021
- **Last updated:** 06/20/2024

## 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 |