NPIMap

Organization Active NPI

Montezuma Health Care Center LLC

  • Respite Care
  • Montezuma, GA
National Provider Identifier
1477574077
Registry record updated Jun 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Respite CareTaxonomy code 385H00000X
License
1-094-1731 Issued in GA
Legal business name
MONTEZUMA HEALTH CARE CENTER LLC
Practice address
506 Sumter St
Montezuma, GA 31063-1734
Phone
(478) 472-8168
Fax
(478) 472-2373
NPI assigned
Jul 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2008

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

Authorized official

Name
Jackie Crisp
Title
Administrator
Phone
(478) 472-8168

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Respite Care 385H00000X 1-094-1731 GA Primary

Addresses

Primary practice location

506 Sumter St
Montezuma, GA 31063-1734

Mailing address

PO Box 639
Montezuma, GA 31063-0639
Phone (478) 472-8168

Other identifiers 1

IdentifierTypeStateIssuer
287282627AMedicaidGA

Other names 1

  • Montezuma Health Care Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Montezuma Health Care Center3 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.

NPI Registry JSON

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214265600000",
    "number": "1477574077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639",
            "city": "MONTEZUMA",
            "state": "GA",
            "postal_code": "310630639",
            "telephone_number": "478-472-8168",
            "fax_number": "478-472-2373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 SUMTER ST",
            "city": "MONTEZUMA",
            "state": "GA",
            "postal_code": "310631734",
            "telephone_number": "478-472-8168",
            "fax_number": "478-472-2373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTEZUMA HEALTH CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2008-06-24",
        "status": "A",
        "authorized_official_last_name": "CRISP",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "478-472-8168"
    },
    "taxonomies": [
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "GA",
            "license": "1-094-1731",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287282627A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Montezuma Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montezuma, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; 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.