Healthcare Provider Details

I. General information

NPI: 1891049102
Provider Name (Legal Business Name): OCONEE HEALTH CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 COLISEUM DR
MACON GA
31217-0104
US

IV. Provider business mailing address

PO BOX 26698
MACON GA
31221-6698
US

V. Phone/Fax

Practice location:
  • Phone: 478-972-0277
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: FARHAN SIDDIQUI
Title or Position: CEO
Credential: MD
Phone: 478-972-0277