Healthcare Provider Details

I. General information

NPI: 1225035462
Provider Name (Legal Business Name): THE SPECIALTY HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 TURNER MCCALL BLVD.
ROME GA
30165-5621
US

IV. Provider business mailing address

320 TURNER MCCALL BLVD.
ROME GA
30165-5621
US

V. Phone/Fax

Practice location:
  • Phone: 706-509-4100
  • Fax: 706-509-4150
Mailing address:
  • Phone: 706-509-4100
  • 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 Code284300000X
TaxonomySpecial Hospital
License Number057589
License Number StateGA

VIII. Authorized Official

Name: MR. TERRANCE K. DILLON
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 502-596-7220