Provider Demographics
NPI:1245431691
Name:GIBSON HEALTH CARE LLC
Entity type:Organization
Organization Name:GIBSON HEALTH CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-547-2591
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:KEYSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30816-0220
Mailing Address - Country:US
Mailing Address - Phone:706-547-2591
Mailing Address - Fax:706-547-2592
Practice Address - Street 1:1005 HIGHWAY 88 NORTH
Practice Address - Street 2:
Practice Address - City:KEYSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30816-4418
Practice Address - Country:US
Practice Address - Phone:706-547-2591
Practice Address - Fax:706-547-2592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000141655AMedicaid
115644Medicare Oscar/Certification