1164849774 NPI number — HART COUNTY HEALTH & REHABILITATION, LLC

Table of content: (NPI 1164849774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164849774 NPI number — HART COUNTY HEALTH & REHABILITATION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HART COUNTY HEALTH & REHABILITATION, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HARTWELL HEALTH AND REHABILITATION
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164849774
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
94 CADE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARTWELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30643-1814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-856-6982
Provider Business Mailing Address Fax Number:
706-856-6989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
94 CADE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTWELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30643-1814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-856-6982
Provider Business Practice Location Address Fax Number:
706-856-6989
Provider Enumeration Date:
03/20/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WINFREY
Authorized Official First Name:
TANYA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
706-856-6982

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1-073-2038 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000141413A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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