NPIMap

Organization Active NPI

Tift County Board of Health D/B/a Diversified Enterprises

  • In Home Supportive Care Agency
  • Tifton, GA
National Provider Identifier
1033404702
Registry record updated Jun 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
Legal business name
TIFT COUNTY BOARD OF HEALTH D/B/A DIVERSIFIED ENTERPRISES
Practice address
192 Virginia Ave S
Suite 100
Tifton, GA 31794-8074
Phone
(229) 386-3122
Fax
(229) 386-7156
NPI assigned
Jun 10, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Theresa Durden
Title
Web Portal Manager
Phone
(229) 386-3122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X Primary

Addresses

Primary practice location

192 Virginia Ave S
Suite 100
Tifton, GA 31794-8074

Mailing address

192 Virginia Ave S
Suite 100
Tifton, GA 31794-8074
Phone (229) 386-3122

Other identifiers 1

IdentifierTypeStateIssuer
000609771ASMedicaidGA

National Provider Directory

National Provider Directory
Tax ID family
Tift County Board of Health Dba Diversified Enterprises31 organizations share this tax ID, including this one

Other organizations with this tax ID 30

Organizations that report the same tax identification number in the National Provider Directory.

View all 30

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1307664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307664000000",
    "number": "1033404702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "192 VIRGINIA AVE S",
            "address_2": "SUITE 100",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317948074",
            "telephone_number": "229-386-3122",
            "fax_number": "229-386-7156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "192 VIRGINIA AVE S",
            "address_2": "SUITE 100",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317948074",
            "telephone_number": "229-386-3122",
            "fax_number": "229-386-7156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIFT COUNTY BOARD OF HEALTH D/B/A DIVERSIFIED ENTERPRISES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-10",
        "last_updated": "2011-06-10",
        "status": "A",
        "authorized_official_last_name": "DURDEN",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "WEB PORTAL MANAGER",
        "authorized_official_telephone_number": "229-386-3122"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000609771AS",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tifton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.