Healthcare Provider Details

I. General information

NPI: 1699764894
Provider Name (Legal Business Name): PEACHBELT HEALTH AND REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ELBERTA RD
WARNER ROBINS GA
31093-1735
US

IV. Provider business mailing address

801 ELBERTA RD
WARNER ROBINS GA
31093-1735
US

V. Phone/Fax

Practice location:
  • Phone: 478-923-3156
  • Fax: 478-923-9040
Mailing address:
  • Phone: 478-923-3156
  • Fax: 478-923-9040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-076-1576
License Number StateGA

VIII. Authorized Official

Name: MRS. DEBORAH L MEADE
Title or Position: OPERATOR
Credential:
Phone: 478-328-3800