Provider Demographics
NPI:1164642484
Name:SKIDAWAY HEALTH AND LIVING SERVICES, INC.
Entity type:Organization
Organization Name:SKIDAWAY HEALTH AND LIVING SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE BOARD OF DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:W
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-598-9402
Mailing Address - Street 1:95 SKIDAWAY ISLAND PARK RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31411-1104
Mailing Address - Country:US
Mailing Address - Phone:912-598-5030
Mailing Address - Fax:912-598-0145
Practice Address - Street 1:95 SKIDAWAY ISLAND PARK RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31411-1104
Practice Address - Country:US
Practice Address - Phone:912-598-5030
Practice Address - Fax:912-598-3610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANHA005038313M00000X
GA025-03-021-1310400000X
GA025-R-0040251E00000X
GA1-025-1850314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA115715Medicare Oscar/Certification