STATEWIDE HEALTHCARE, INC. (NPI# 1053477877) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053477877 |
| Entity Type | Organization |
| Organization Name | STATEWIDE HEALTHCARE, INC. |
| Practice Address |
714 Martin Luther King Jr Blvd Suit 100 Savannah GA 31401-5570 |
| Practice Telephone | 9122318958 |
| Mailing Telephone | 9122318958 |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | J. CRAIG GORDON (CEO) |
| Authorized Official Telephone | 9122318958 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
621610 | GA | Nursing & Custodial Care Facilities |
| Street Address |
714 MARTIN LUTHER KING JR BLVD SUIT 100 |
| City | SAVANNAH |
| State | GA |
| Zip Code | 31401-5570 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780740506 | Statewide Healthcare, Inc | Clinic/Center | 714 Martin Luther King Jr Blvd, Suit 100, Savannah, GA 31401-5570 | 2006-12-28 |
| 1134420664 | Delta Solutions Health and Educational Services, Inc. | Community/Behavioral Health | 714 Martin Luther King Jr Blvd, Suite3, Savannah, GA 31401-5570 | 2010-11-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760031470 | Leslie Beatrice Dixon | Technician | 1109 Harmon Street, Savannah, GA 31401 | 2019-09-05 |
| 1912444621 | Sarah Kristen Shuman | Counselor | 140 East 40th St, Savannah, GA 31401 | 2017-01-20 |
| 1427591791 | Catherine Naomi Spann | Licensed Practical Nurse | 107 B Fahm Street, Savannag, GA 31401 | 2016-11-18 |
| 1871952499 | Jesline Palmer | Case Manager/Care Coordinator | 466 Martin Luther King Blvd, Savanah, GA 31401 | 2016-02-11 |
| 1487012894 | Suzanne Waltman Coote | Social Worker | 127 Abercorn St, Suite 301b, Savannah, GA 31401 | 2016-02-01 |
| 1356748032 | Beverly Weaver | Registered Nurse | 107 B Fahm St., Savannah, GA 31401 | 2014-11-25 |
| 1275938011 | Olukemi Olubajo | Dietitian, Registered | 125 Fahm Street, J C Lewis Primary Health Care Center, Savannah, GA 31401 | 2014-10-22 |
| 1346642279 | Kristin Jaski | Social Worker | 127 Abercorn St, Suite 301b, Savannah, GA 31401 | 2014-09-23 |
| 1528497500 | Kathleen Alice Flynn | Nurse Practitioner | 1900 Abercorn Street, Suite 100, Savannah, GA 31401 | 2013-11-11 |
| 1306112248 | Elizabeth Windom Stewart | Nurse Practitioner | 300 Bull St Ste 102, Savannah, GA 31401 | 2012-03-26 |
| Find all providers in zip 31401 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750995155 | Jacqueline Dingle | Custodial Care Facility | 604 Sugarbush Cir, Savannah, GA 31406-4434 | 2020-09-02 |
| 1134604374 | Irene's Family & Friends Indulgent (iffi) Care, LLC | Custodial Care Facility | 12502 Cranwood Ln, Savannah, GA 31419-2646 | 2018-10-03 |
| 1710472857 | Catering To Care Personal Care Home | Custodial Care Facility | 405 Barnhill Dr, Savannah, GA 31406-5912 | 2018-06-29 |
| 1184920662 | Snilloc, Inc | Custodial Care Facility | 1402 Addie B Byers Dr, Savannah, GA 31415-7874 | 2011-02-01 |
| 1669602546 | Charis Assisted Living Homes LLC | Custodial Care Facility | 1914 Skidaway Rd, Savannah, GA 31404-2328 | 2009-07-25 |
| 1922452986 | Favor of Favor LLC | Custodial Care Facility | 203 Van Nuys Blvd, Savannah, GA 31419-1341 | 2016-04-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679174437 | United Hands Support Services | Custodial Care Facility | 735 Ridge Rd, Canton, GA 30114-4170 | 2020-11-06 |
| 1679174429 | Golden Peak Senior Living Corp | Custodial Care Facility | 411 Edmond St, Calhoun, GA 30701-5334 | 2020-11-06 |
| 1023615531 | Lillian Womble | Custodial Care Facility | 3232 Union Church Road, Warthen, GA 31094 | 2020-10-07 |
| 1114549763 | Idella's Angels | Custodial Care Facility | 270 13th Ave Sw, Cairo, GA 39828-3423 | 2020-05-16 |
| 1356962062 | Brendas Love Personal Care Home LLC | Custodial Care Facility | 8239 Queens Dr, Jonesboro, GA 30238-2946 | 2020-05-04 |
| 1801421094 | Lj's Personal Care Home, LLC | Custodial Care Facility | 415 E 18th St Sw, Rome, GA 30161-6544 | 2020-03-08 |
| 1356984041 | Manuel Carl Mckenzie IIi | Custodial Care Facility | 4893 Candlewood Ln, Stone Mountain, GA 30088-1605 | 2019-10-24 |
| 1457904310 | Renaissance Healthcare LLC | Custodial Care Facility | 419 Airport Rd, Griffin, GA 30224-4834 | 2019-07-19 |
| 1225697873 | Tahirah Johnston | Custodial Care Facility | 1657 Hallmark Hills Dr, Griffin, GA 30223-8790 | 2019-06-07 |
| 1508420613 | Rosa Amanda Hill | Custodial Care Facility | 1073 Davis Rd, Culloden, GA 31016-5843 | 2019-04-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.