Healthcare Provider Details

I. General information

NPI: 1497728505
Provider Name (Legal Business Name): MOLENA HEALTH & REHAB, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 06/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 HILL ST
MOLENA GA
30258-3115
US

IV. Provider business mailing address

185 HILL ST
MOLENA GA
30258-3115
US

V. Phone/Fax

Practice location:
  • Phone: 770-884-5138
  • Fax: 770-884-5484
Mailing address:
  • Phone: 770-884-5138
  • Fax: 770-884-5484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-114-1948
License Number StateGA

VIII. Authorized Official

Name: MR. ANDREW J. MORRIS
Title or Position: C.E.O.
Credential:
Phone: 770-884-5138