Provider Demographics
NPI:1043287303
Name:CHATUGE REGIONAL HOSPITAL INC
Entity type:Organization
Organization Name:CHATUGE REGIONAL HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SELF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:706-439-6812
Mailing Address - Street 1:386 BEL AIRE DR
Mailing Address - Street 2:
Mailing Address - City:HIAWASSEE
Mailing Address - State:GA
Mailing Address - Zip Code:30546-3313
Mailing Address - Country:US
Mailing Address - Phone:706-896-2231
Mailing Address - Fax:706-896-7584
Practice Address - Street 1:386 BEL AIRE DR
Practice Address - Street 2:
Practice Address - City:HIAWASSEE
Practice Address - State:GA
Practice Address - Zip Code:30546-3313
Practice Address - Country:US
Practice Address - Phone:706-896-2231
Practice Address - Fax:706-896-7584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11391595314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000143338AMedicaid
GA115701Medicare ID - Type Unspecified
GA000143338AMedicaid