Provider Demographics
NPI:1316243926
Name:RICHMOND COUNTY HOSPITAL AUTHORITY
Entity type:Organization
Organization Name:RICHMOND COUNTY HOSPITAL AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-774-8061
Mailing Address - Street 1:6698 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:APPLING
Mailing Address - State:GA
Mailing Address - Zip Code:30802-4120
Mailing Address - Country:US
Mailing Address - Phone:706-541-0462
Mailing Address - Fax:706-541-0310
Practice Address - Street 1:6698 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:APPLING
Practice Address - State:GA
Practice Address - Zip Code:30802-4120
Practice Address - Country:US
Practice Address - Phone:706-541-0462
Practice Address - Fax:706-541-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00403939AMedicaid
115424Medicare Oscar/Certification