NPIMap

Organization Active NPI

Hiawatha Private Healthcare Service, LLC

  • In Home Supportive Care Agency
  • Augusta, GA
National Provider Identifier
1285390716
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
Legal business name
HIAWATHA PRIVATE HEALTHCARE SERVICE, LLC
Doing business as
Hiawatha Private Healthcare Service, LLC
Practice address
3424 Kensington Dr S
Augusta, GA 30906-6002
Phone
(706) 306-0091
Fax
(706) 796-0261
NPI assigned
Nov 9, 2021
Last updated
Jun 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

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

Authorized official

Name
Ms. Hiawatha Vennessa Rainey, CNANPI 1700633930
Title
Administrator
Phone
(706) 306-0091

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

3424 Kensington Dr S
Augusta, GA 30906-6002

Mailing address

3424 Kensington Dr S
Augusta, GA 30906-6002
Phone (706) 306-0091

Other identifiers 4

IdentifierTypeStateIssuer
251X00000XOtherGAPRIVATE HOME CARE PROVIDER
251E00000XOtherGAPRIVATE HOME CARE PROVIDER
253Z00000XOtherGAPRIVATE HOME CARE PROVIDER
251J00000XOtherGAPRIVATE HOME CARE PROVIDER

Other names 1

  • Hiawatha Private Healthcare Service, LLC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1636416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718841600000",
    "number": "1285390716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3424 KENSINGTON DR S",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309066002",
            "telephone_number": "706-306-0091",
            "fax_number": "706-796-0261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3424 KENSINGTON DR S",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309066002",
            "telephone_number": "706-306-0091",
            "fax_number": "706-796-0261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIAWATHA PRIVATE HEALTHCARE SERVICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-09",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A",
        "authorized_official_last_name": "RAINEY",
        "authorized_official_first_name": "HIAWATHA",
        "authorized_official_middle_name": "VENNESSA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "706-306-0091",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CNA"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE HOME CARE PROVIDER",
            "identifier": "251X00000X",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE HOME CARE PROVIDER",
            "identifier": "251E00000X",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE HOME CARE PROVIDER",
            "identifier": "253Z00000X",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE HOME CARE PROVIDER",
            "identifier": "251J00000X",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hiawatha Private Healthcare Service, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hiawatha Private Healthcare Service, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Augusta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; 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.