Healthcare Provider Details

I. General information

NPI: 1174514160
Provider Name (Legal Business Name): KEYSVILLE NURSING HOME & REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 HIGHWAY 88 NORTH
KEYSVILLE GA
30816
US

IV. Provider business mailing address

PO BOX 220
KEYSVILLE GA
30816-0220
US

V. Phone/Fax

Practice location:
  • Phone: 706-547-2591
  • Fax: 706-547-0492
Mailing address:
  • Phone: 706-547-2591
  • Fax: 706-547-0492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-017-1616
License Number StateGA

VIII. Authorized Official

Name: MRS. LOIS N PARRISH
Title or Position: ADMINISTRATOR
Credential:
Phone: 706-547-2591