NPIMap

Organization Active NPI

Statewide Health Care Inc

  • Community/Behavioral Health Agency
  • Savannah, GA
National Provider Identifier
1295279495
Registry record updated Dec 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
STATEWIDE HEALTH CARE INC
Practice address
102 Oglethorpe Professional CT
Suite 4
Savannah, GA 31406-3600
Phone
(912) 231-8958
Fax
(912) 234-7701
NPI assigned
Dec 7, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2016

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

Authorized official

Name
J Craig Gordon
Title
Ceo
Phone
(912) 231-8958

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

102 Oglethorpe Professional CT
Suite 4
Savannah, GA 31406-3600

Mailing address

102 Oglethorpe Professional CT
Suite 4
Savannah, GA 31406-3600
Phone (912) 231-8958

Other identifiers 7

IdentifierTypeStateIssuer
000621288AMedicaidGA
000510243CMedicaidGA
000510243DMedicaidGA
000510529BMedicaidGA
000510529AAMedicaidGA
000510243BMedicaidGA
000510529YMedicaidGA

National Provider Directory

National Provider Directory
Tax ID family
Statewide Healthcare Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1481068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481068800000",
    "number": "1295279495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 OGLETHORPE PROFESSIONAL CT",
            "address_2": "SUITE 4",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314063600",
            "telephone_number": "912-231-8958",
            "fax_number": "912-234-7701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 OGLETHORPE PROFESSIONAL CT",
            "address_2": "SUITE 4",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314063600",
            "telephone_number": "912-231-8958",
            "fax_number": "912-234-7701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATEWIDE HEALTH CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-07",
        "last_updated": "2016-12-07",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "J CRAIG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-231-8958"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000621288A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000510243C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000510243D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000510529B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000510529AA",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000510243B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000510529Y",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2016; 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.