Healthcare Provider Details

I. General information

NPI: 1558357368
Provider Name (Legal Business Name): MARIETTA HEALTH AND REHABILITATION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SAINE DR SW
MARIETTA GA
30008-3824
US

IV. Provider business mailing address

50 SAINE DR SW
MARIETTA GA
30008-3824
US

V. Phone/Fax

Practice location:
  • Phone: 770-429-8600
  • Fax: 770-429-8677
Mailing address:
  • Phone: 770-429-8600
  • Fax: 770-429-8677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-033-1793
License Number StateGA

VIII. Authorized Official

Name: MR. RICHARD EDWARD FALLAW SR.
Title or Position: PRESIDENT
Credential:
Phone: 229-268-7510