Provider Demographics
NPI:1548250939
Name:BANKS-JACKSON-COMMERCE HOSPITAL AND NURSING HOME AUTHORITY
Entity type:Organization
Organization Name:BANKS-JACKSON-COMMERCE HOSPITAL AND NURSING HOME AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:YARBOROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-335-1102
Mailing Address - Street 1:70 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-1078
Mailing Address - Country:US
Mailing Address - Phone:706-335-1000
Mailing Address - Fax:706-335-7701
Practice Address - Street 1:70 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-1078
Practice Address - Country:US
Practice Address - Phone:706-335-1000
Practice Address - Fax:706-335-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA78-12282N00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered282N00000XHospitalsGeneral Acute Care Hospital
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00000151AMedicaid
GA110040Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER