Pioneer Health Services of Early County, LLC

Key facts

NPI: 1386952141
Entity type: Organization (NPI type 2)
Primary specialty: Skilled Nursing Facility 314000000X
License: 049-667 (GA)
Legal business name: PIONEER HEALTH SERVICES OF EARLY COUNTY, LLC
Practice address: 11740 Columbia St
Blakely, GA 39823-2574
Phone: (229) 723-3795
Fax: (229) 723-8024
NPI assigned: Sep 15, 2010
Organization subpart: No

Authorized official

Name: Mr. Joseph S McNulty III
Title: Ceo
Phone: (601) 849-6440

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Skilled Nursing Facility	314000000X	049-667	GA	Yes

Addresses

Primary practice location

11740 Columbia St
Blakely, GA 39823-2574

Mailing address

11740 Columbia St
Blakely, GA 39823-2574
Phone (229) 723-3795

Other identifiers

Identifier	Type	State	Issuer
049-667	Other	GA	LICENSE
00140873A	Medicaid	GA

Other names

Early Memorial Nursing Home Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 23, 2015.

{
    "created_epoch": "1284508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442966400000",
    "number": "1386952141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11740 COLUMBIA ST",
            "city": "BLAKELY",
            "state": "GA",
            "postal_code": "398232574",
            "telephone_number": "229-723-3795",
            "fax_number": "229-723-8024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11740 COLUMBIA ST",
            "city": "BLAKELY",
            "state": "GA",
            "postal_code": "398232574",
            "telephone_number": "229-723-3795",
            "fax_number": "229-723-8024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIONEER HEALTH SERVICES OF EARLY COUNTY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-15",
        "last_updated": "2015-09-23",
        "status": "A",
        "authorized_official_last_name": "MCNULTY",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-849-6440",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "049-667",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "049-667",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00140873A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Early Memorial Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blakely, GA

All providers in Blakely, GA · Skilled Nursing Facility in Georgia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2015. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.