NPIMap

Organization Active NPI

Azalea Rehab Services, LLC

  • Speech-Language Pathologist
  • Valdosta, GA
National Provider Identifier
1992062426
Registry record updated Dec 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
AZALEA REHAB SERVICES, LLC
Practice address
2301 Bemiss Rd
Valdosta, GA 31602-1934
Phone
(229) 244-1667
Fax
(229) 244-8253
NPI assigned
Apr 22, 2012
Last updated
Dec 20, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2021

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

Authorized official

Name
Heather Delaney, CCC-SLPNPI 1902194038
Title
Owner
Phone
(229) 300-9365

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU
Occupational Therapist 225X00000X NU
Speech-Language Pathologist 235Z00000X NU Primary

Addresses

Primary practice location

2301 Bemiss Rd
Valdosta, GA 31602-1934

Mailing address

2301 Bemiss Rd
Valdosta, GA 31602-1934
Phone (229) 244-1667

Other identifiers 3

IdentifierTypeStateIssuer
003124189AMedicaidGA
003107600CMedicaidGA
003110551CMedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141016001158 GA Part B Supplier - Clinic/Group Practice 2365608692 Receives reassigned benefits from 16 practitioners
Practice locations: Valdosta, GA

National Provider Directory

National Provider Directory

Locations

2301 Bemiss Rd
Valdosta, GA 31602
Phone (229) 241-0011

304 Emory St
Valdosta, GA 31602
Phone (229) 244-1667

Practitioners & affiliated clinicians

Practitioners 23

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.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1335052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639958400000",
    "number": "1992062426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 BEMISS RD",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021934",
            "telephone_number": "229-244-1667",
            "fax_number": "229-244-8253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 BEMISS RD",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021934",
            "telephone_number": "229-244-1667",
            "fax_number": "229-244-8253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AZALEA REHAB SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-22",
        "last_updated": "2021-12-20",
        "certification_date": "2021-12-20",
        "status": "A",
        "authorized_official_last_name": "DELANEY",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-300-9365",
        "authorized_official_credential": "CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003124189A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003107600C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003110551C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valdosta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.