MEDICARE: PHNH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1730529116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHNH LLC

Provider Business Mailing Address
First Line	:	PO BOX 263
Second Line	:	712 PATTERSON ST
City	:	BYROMVILLE
State	:	GA
Zip	:	31007-0263
Country	:	US
Telephone Number	:	478-433-5711
Fax Number	:	478-433-4016

Provider Business Practice Location Address
First Line	:	712 PATTERSON ST
Second Line	:
City	:	BYROMVILLE
State	:	GA
Zip	:	31007-0263
Country	:	US
Telephone Number	:	478-433-5711
Fax Number	:	478-433-4016

Authorized Official
Title or Position	:	SECRETARY
Name	:	NANCY SHMAYS
Credential	:
Telephone Number	:	770-650-7086

Provider Enumeration Date	:	06/28/2013
Last Update Date	:	06/28/2013

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