JESUP HEALTHCARE
NPI 1679514434
Skilled Nursing Facility in Jesup, GA

Active since June 10, 2006CLIA 11D0709639 · Waiver
3100 SAVANNAH HWY, JESUP, GA 31545(912) 427-6873(912) 530-6713 Get Directions Write a Review

NPPES record last updated: September 29, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jesup Healthcare NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JESUP HEALTHCARE (NPI 1679514434) is a healthcare organization registered as a skilled nursing facility in Jesup, Georgia and active in the NPI registry since June 2006. The organization holds a CLIA Waiver certificate valid through November 13, 2026 and lists Tygh Angwin Brogdon, Manager, as its authorized official.

NPPES Registry Identity

NPI1679514434
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameJESUP HEALTHCARE LLC
Location Address3100 SAVANNAH HWYJesup, GA 31545-5514
Mailing Address3100 Savannah HwyJesup, GA 31545-5514 · (912) 427-6873 · Fax (912) 530-6713
Fax(912) 530-6713
Organization SubpartNo
Authorized OfficialTygh Angwin BrogdonManager · (770) 650-8773
Enumeration DateJune 10, 2006
Last NPPES UpdateSeptember 29, 2008
NPI 1679514434 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License Licensed in GA · 1-151-1864
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
3100 SAVANNAH HWY, Jesup, GA 31545

Other Names 1

Doing Business AsJesup Healthcare

Other Identifiers 2

Medicare ID-Type Unspecified11-5503Mutual Of Omaha
Medicaid000142689AGA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D0709639

Jesup Healthcare · Jesup, GA
Active · expires Nov 13, 2026
CLIA Number11D0709639
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateNovember 14, 2024
Certificate Expiration DateNovember 13, 2026
Laboratory DirectorDedra S. Eason
Laboratory Phone(912) 427-6873
Laboratory LocationJesup Healthcare3100 Savannah Highway, Jesup, GA 31545
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Occupational Therapist
3100 SAVANNAH HWY
JESUP, GA 31545
Physical Therapy Assistant
3100 SAVANNAH HWY
JESUP, GA 31545
Physical Therapist
3100 SAVANNAH HWY
JESUP, GA 31545
Physical Therapist
3100 SAVANNAH HWY
JESUP, GA 31545
Occupational Therapist
3100 SAVANNAH HWY
JESUP, GA 31545
Skilled Nursing Facility
3100 SAVANNAH HWY
JESUP, GA 31545
Skilled Nursing Facility
3100 SAVANNAH HWY
JESUP, GA 31545

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jesup Healthcare LLC's NPI number?

The NPI number for Jesup Healthcare LLC is 1679514434. It was assigned to this organization in the NPPES registry on June 10, 2006. The provider is doing business as Jesup Healthcare.

Where is Jesup Healthcare LLC located?

Jesup Healthcare LLC is located at 3100 Savannah Hwy, Jesup, GA 31545. The listed phone number is (912) 427-6873.

What is Jesup Healthcare LLC's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Jesup Healthcare LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D0709639) is associated with this NPI, valid through November 13, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Jesup Healthcare LLC was last updated on September 29, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.