Organization
STATEWIDE HEALTHCARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
J. CRAIG GORDON (CEO)
(912) 231-8958
Entity
Organization
Contact information
Practice address
102 OGLETHORPE PROFESSIONAL CT, SUITE 4, SAVANNAH, GA 31406-3600
(912) 231-8958
Mailing address
102 OGLETHORPE PROFESSIONAL CT, SUITE 4, SAVANNAH, GA 31406-3600
(912) 231-8958
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
621610
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000510243B
—
GA
05
—
000510243C
—
GA
05
—
000510243D
—
GA
05
—
000510529B
—
GA
05
—
000621288A
—
GA
Enumeration date
12/22/2006
Last updated
04/06/2011
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