Public Health Personal Support Services, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

092-R-002 Issued in GA

Legal business name

PUBLIC HEALTH PERSONAL SUPPORT SERVICES, INC.

Practice address

1811 Green Cir
Valdosta, GA 31602-2734

Phone

(229) 253-1164

Fax

(229) 253-1151

NPI assigned

Jul 29, 2006

Last updated

Aug 10, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Denise Retterbush, RN

Title

Ceo

Phone

(229) 253-1067

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691625600000",
    "number": "1255345534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3284",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316043284",
            "telephone_number": "229-253-1164",
            "fax_number": "229-253-1151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 GREEN CIR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316022734",
            "telephone_number": "229-253-1164",
            "fax_number": "229-253-1151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HEALTH PERSONAL SUPPORT SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A",
        "authorized_official_last_name": "RETTERBUSH",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "229-253-1067",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "GA",
            "license": "092-R-002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00621013A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00056845H",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2023; 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.