NPIMap

Organization Active NPI

Altamaha Homecare, Inc.

  • Home Health Agency
  • Baxley, GA
National Provider Identifier
1336158336
Registry record updated Oct 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
001-289-H Issued in GA
Legal business name
ALTAMAHA HOMECARE, INC.
Practice address
52 N Oak St
Baxley, GA 31513-0031
Phone
(912) 367-1046
Fax
(912) 366-0068
NPI assigned
Aug 7, 2006
Last updated
Oct 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2025

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

Authorized official

Name
Lisa Deen
Title
Financial Director
Phone
(912) 367-1046

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 001-289-H GA Primary

Addresses

Primary practice location

52 N Oak St
Baxley, GA 31513-0031

Mailing address

52 N Oak St
Baxley, GA 31513-0031
Phone (912) 367-1046

Other identifiers 4

IdentifierTypeStateIssuer
000490267DMedicaidGA
000791381CMedicaidGA
300028918DMedicaidGA
000791381EMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050207000022 GA Part A Provider - Home Health Agency 8820049976 Practice locations: Baxley, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336158336. Details of each certification follow.

Home health agency certification: CCN 117074

Legal name
ALTAMAHA HOMECARE, INC.
Certification status
Active
Provider type (POS)
Home health agency
Participating since
May 29, 1979
Last certification
Oct 4, 2017
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Oct 1, 1991 in GA
Enrollment address
52 N Oak St
Baxley, GA 31513-0031

Care Compare: Home health agency

Medicare Care Compare
Listed as
Altamaha Homecare, IncCCN 117074 · All quality measures
Overall star rating
2.5 of 5
Ownership
Proprietary
Certified
May 29, 1979
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Altamaha Homecare Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
James Bennett Individual 5% Or Greater Direct Ownership Interest Jun 27, 2025 100%
Corporate OfficerChief Executive Officer Jun 27, 2025 100%
W-2 Managing EmployeeAd; Jun 27, 2025 100%

Practitioners & affiliated clinicians

Affiliated clinicians 7

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760918400000",
    "number": "1336158336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 N OAK ST",
            "city": "BAXLEY",
            "state": "GA",
            "postal_code": "315130031",
            "telephone_number": "912-367-1046",
            "fax_number": "912-366-0068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 N OAK ST",
            "city": "BAXLEY",
            "state": "GA",
            "postal_code": "315130031",
            "telephone_number": "912-367-1046",
            "fax_number": "912-366-0068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTAMAHA HOMECARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-07",
        "last_updated": "2025-10-20",
        "certification_date": "2025-10-20",
        "status": "A",
        "authorized_official_last_name": "DEEN",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "FINANCIAL DIRECTOR",
        "authorized_official_telephone_number": "912-367-1046"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "GA",
            "license": "001-289-H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000490267D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000791381C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300028918D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000791381E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baxley, GA

Sources for this page

Verify at the official NPI Registry.