Healthcare Provider Details

I. General information

NPI: 1972558989
Provider Name (Legal Business Name): ERIN NURSING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 SIMMONS STREET
DUBLIN GA
31021-3918
US

IV. Provider business mailing address

5057 TROY ROAD
SPRINGFIELD OH
45502-8150
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-1666
  • Fax: 478-275-2146
Mailing address:
  • Phone: 937-964-8974
  • Fax: 937-964-8961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-087-1633
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-087-1983
License Number StateGA

VIII. Authorized Official

Name: BOYD P GENTRY JR.
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 937-964-8974