NPIMap

Organization Active NPI

Southeast Georgia Health System, Inc.

  • Skilled Nursing Facility
  • Saint Marys, GA
National Provider Identifier
1720169147
Registry record updated Nov 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
SOUTHEAST GEORGIA HEALTH SYSTEM, INC.
Practice address
805 Dilworth St
Saint Marys, GA 31558-8673
Phone
(912) 882-4281
Fax
(912) 882-9502
NPI assigned
Oct 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2022

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

Authorized official

Name
Mr. Scott Raynes, MBA, MA
Title
President & Ceo
Phone
(912) 466-7049

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

805 Dilworth St
Saint Marys, GA 31558-8673

Mailing address

2415 Parkwood Dr
Brunswick, GA 31520-4722
Phone (912) 466-7000

Other identifiers 1

IdentifierTypeStateIssuer
00143129AMedicaidGA

Other names 1

  • Senior Care Center - St. Marys Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150727002823 GA Part A Provider - Skilled Nursing Facility 8729076740 Practice locations: St. Marys, GA

Skilled nursing facility certification: CCN 115684

Legal name
SOUTHEAST GEORGIA HEALTH SYSTEM, INC
Doing business as
SENIOR CARE CENTER - ST. MARYS
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 20, 2003
Last certification
Mar 14, 2024
Beds
78
Ownership / control type
Limited Liability Corporation
Multi-facility organization
PRUITTHEALTH
Organization structure
CorporationNon-profit
Incorporated
Mar 13, 1990 in GA
Enrollment address
805 Dilworth Street
St. Marys, GA 31558-8673
Nursing home name
SENIOR CARE CENTER - ST MARYS

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Senior Care Center - St MarysCCN 115684
Overall star rating
1 of 5
Health inspections
2 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Mar 20, 2003
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7863.8 residents per day on average
Penalties (3 years)
1Fines totaling $4,072

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0646129Southeast Georgia Health System, Inc D/B/a805 Dilworth St, Saint Marys, GA 31558Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Camden Medical 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.

Locations

3025 Shrine Rd
Ste 160
Brunswick, GA 31520
Phone (912) 466-1240

3003 Kemble Ave
Brunswick, GA 31520
Phone (912) 466-5320

805 Dilworth St
Saint Marys, GA 31558
Phone (912) 882-4227

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Stephen a Chitty Individual Corporate DirectorBoard Member May 1, 2016
Jeffery Barker Individual Corporate DirectorBoard Member May 1, 2018
Kay Hampton Individual Corporate DirectorBoard Member May 1, 2016
William O'Neil Suddath Individual Corporate DirectorBoard Member Jan 1, 2023
Denny a Carter Individual Corporate OfficerBoard Member Jan 1, 2024
Catina Tindall Individual Corporate OfficerVice Chair May 1, 2023
Corporate DirectorVice Chair May 1, 2023
Angelito B Lacanilao Individual Adp of the SNF Apr 14, 2025
Valerie a. Hepburn Individual Corporate DirectorBoard Member May 1, 2015
Roosevelt Harris Individual Corporate DirectorBoard Member Jan 1, 2024
Christy Jordan Individual Corporate OfficerInterim Ceo and Ao Mar 3, 2024
Rhondia L Grant Individual Operational/Managerial Control Aug 26, 2024
Adp of the SNF Apr 14, 2025
Shirley D Wilson Individual Corporate DirectorBoard Member May 1, 2019
Pruitthealth St Mary'S Organization, Norcross, GA Management services company Operational/Managerial Control Sep 1, 2024
Angela L Heys Individual Corporate DirectorBoard Member Jan 1, 2024
Southeast Georgia Health System, Inc Organization, Brunswick, GA Operational/Managerial Control May 1, 2015
James B Loomis Individual Corporate OfficerDirector/Officer May 1, 2020
Corporate DirectorDirector/Officer May 1, 2020
Michael Hodges Individual Corporate DirectorVice Chair May 1, 2015
Robert C Turner Individual Corporate DirectorCurrent Board Member May 1, 2015

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Senior Care Center - BrunswickBrunswick, GA, CCN 115721 Skilled nursing facility Operational/Managerial Control May 1, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 3

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": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667779200000",
    "number": "1720169147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2415 PARKWOOD DR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315204722",
            "telephone_number": "912-466-7000",
            "fax_number": "912-466-7026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 DILWORTH ST",
            "city": "SAINT MARYS",
            "state": "GA",
            "postal_code": "315588673",
            "telephone_number": "912-882-4281",
            "fax_number": "912-882-9502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST GEORGIA HEALTH SYSTEM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2022-11-07",
        "certification_date": "2022-02-21",
        "status": "A",
        "authorized_official_last_name": "RAYNES",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "912-466-7049",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA, MA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00143129A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Senior Care Center - St. Marys",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Senior Care Center - St. Marys",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Marys, GA

Sources for this page

Verify at the official NPI Registry.