Provider Demographics
NPI:1386708154
Name:SPEECH HEARING AND REHABILITATION ENTERPRISES OF COASTAL GEORGIA INC.
Entity type:Organization
Organization Name:SPEECH HEARING AND REHABILITATION ENTERPRISES OF COASTAL GEORGIA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECOTR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:MEADOWS
Authorized Official - Last Name:USSERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-264-3141
Mailing Address - Street 1:2228 STARLING ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4200
Mailing Address - Country:US
Mailing Address - Phone:912-264-3141
Mailing Address - Fax:912-264-6190
Practice Address - Street 1:2228 STARLING ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4200
Practice Address - Country:US
Practice Address - Phone:912-264-3141
Practice Address - Fax:912-264-6190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008488225100000X
GASLP001913235Z00000X
GASLP002066235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA116505Medicare UPIN