Healthcare Provider Details

I. General information

NPI: 1275514259
Provider Name (Legal Business Name): RANDOLPH COUNTY HEALTH AND REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 RANDOLPH ST
CUTHBERT GA
39840-6127
US

IV. Provider business mailing address

321 RANDOLPH ST
CUTHBERT GA
39840-6127
US

V. Phone/Fax

Practice location:
  • Phone: 229-732-2288
  • Fax: 229-732-2382
Mailing address:
  • Phone: 229-732-2288
  • Fax: 229-732-2382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00141633A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name: ADRIAN LEWIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 229-732-2288