Healthcare Provider Details

I. General information

NPI: 1841262912
Provider Name (Legal Business Name): FARMORE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 LONGSTREET RD
ELBERTON GA
30635-5185
US

IV. Provider business mailing address

1043 LONGSTREET RD
ELBERTON GA
30635-5185
US

V. Phone/Fax

Practice location:
  • Phone: 706-283-5429
  • Fax: 706-213-9301
Mailing address:
  • Phone: 706-283-5429
  • Fax: 706-213-9301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-052-1638
License Number StateGA

VII. Legacy identifiers

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

# 1
Identifier00082981A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name: MRS. LYNN H BLACKMON
Title or Position: NHA, PRESIDENT OWNER/OPERATOR
Credential:
Phone: 706-283-2194