Healthcare Provider Details

I. General information

NPI: 1023002995
Provider Name (Legal Business Name): WARREN COUNTY HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 ATLANTA HWY
WARRENTON GA
30828-9105
US

IV. Provider business mailing address

110 PLANTATION CHASE
ST SIMONS IS GA
31522-1622
US

V. Phone/Fax

Practice location:
  • Phone: 706-465-3328
  • Fax: 706-465-1119
Mailing address:
  • Phone: 706-465-3328
  • Fax: 706-465-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-149-1472
License Number StateGA

VIII. Authorized Official

Name: BARBARA PHILLIPS
Title or Position: ADMINISTRATOR
Credential:
Phone: 706-465-3328