Healthcare Provider Details

I. General information

NPI: 1982090486
Provider Name (Legal Business Name): ROOSEVELT WARM SPRINGS REHABILITATION & SPECIALTY HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6135 ROOSEVELT HIGHWAY
WARM SPRINGS GA
31830-0280
US

IV. Provider business mailing address

6135 ROOSEVELT HWY POB 280
WARM SPRINGS GA
31830-2757
US

V. Phone/Fax

Practice location:
  • Phone: 706-655-5461
  • Fax: 706-655-5457
Mailing address:
  • Phone: 706-655-5461
  • Fax: 706-655-5457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number099-684
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number099-685
License Number StateGA

VIII. Authorized Official

Name: MRS. SUSAN W WILDER
Title or Position: DIRECTOR OF FINANCE
Credential: CFO
Phone: 706-655-5461