Healthcare Provider Details

I. General information

NPI: 1972597847
Provider Name (Legal Business Name): GLASCOCK COUNTY HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 BEALL SPRINGS RD
GIBSON GA
30810-4224
US

IV. Provider business mailing address

434 BEALL SPRINGS ROAD
GIBSON GA
30810
US

V. Phone/Fax

Practice location:
  • Phone: 706-598-3201
  • Fax: 706-598-3802
Mailing address:
  • Phone: 706-598-5301
  • Fax: 706-598-3802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-062-1049
License Number StateGA

VIII. Authorized Official

Name: PATRELLE MAJOR
Title or Position: ADMINISTRATOR
Credential:
Phone: 706-598-3201