Healthcare Provider Details

I. General information

NPI: 1750381737
Provider Name (Legal Business Name): DADE HEALTH & REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 HIGHWAY 301
TRENTON GA
30752-4727
US

IV. Provider business mailing address

1234 HIGHWAY 301
TRENTON GA
30752-4727
US

V. Phone/Fax

Practice location:
  • Phone: 706-657-4171
  • Fax: 706-657-6799
Mailing address:
  • Phone: 706-657-4171
  • Fax: 706-657-6799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-041-1809
License Number StateGA

VIII. Authorized Official

Name: MR. ANDREW JACKSON MORRIS III
Title or Position: MANAGING MEMBER
Credential:
Phone: 706-378-0940