Active NPI
Christ's Sanctified Holy Church, Inc.
Doing business as Church Home for the Aged
- Skilled Nursing Facility
- Fort Valley, GA
National Provider Identifier
1316935422
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 20635S
- Legal business name
- CHRIST'S SANCTIFIED HOLY CHURCH, INC.
- Doing business as
- Church Home for the Aged
- Practice address
- 2470 US Highway 41
Fort Valley, GA 31030-8716 - Phone
- (478) 987-1239
- Fax
- (478) 988-8273
- NPI assigned
- Oct 12, 2005
- Last updated
- Sep 22, 2011
- Organization subpart
- Yes
- Parent organization
- CHRIST'S SANCTIIFIED HOLY CHURCH, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Kathy Gibbs
- Title
- Administrator
- Phone
- (478) 987-1239
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 20635S | GA | Primary |
Addresses
Primary practice location
2470 US Highway 41
Fort Valley, GA 31030-8716
Mailing address
PO Box 1376
Perry, GA 31069-1376
Phone (478) 987-1239
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004140467A | Medicaid | GA |
Other names 1
- Church Home for the Aged
National Provider Directory
National Provider Directory- Part of
- Christ's Sanctified Holy Church Inc
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.
-
- Family Medicine Physician
- Macon, GA
- NPI 1124407499
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129075200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1316649600000",
"number": "1316935422",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1376",
"city": "PERRY",
"state": "GA",
"postal_code": "310691376",
"telephone_number": "478-987-1239",
"fax_number": "478-988-8273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2470 US HIGHWAY 41",
"city": "FORT VALLEY",
"state": "GA",
"postal_code": "310308716",
"telephone_number": "478-987-1239",
"fax_number": "478-988-8273"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CHRIST'S SANCTIFIED HOLY CHURCH, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "CHRIST'S SANCTIIFIED HOLY CHURCH, INC.",
"enumeration_date": "2005-10-12",
"last_updated": "2011-09-22",
"status": "A",
"authorized_official_last_name": "GIBBS",
"authorized_official_first_name": "KATHY",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "478-987-1239",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "GA",
"license": "20635S",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004140467A",
"state": "GA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Church Home for the Aged",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Fort Valley, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 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.