Healthcare Provider Details

I. General information

NPI: 1578579165
Provider Name (Legal Business Name): BROOKWOOD-MADISON COUNTY CONVALESCENT CENTER LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 MANOR RD
MARS HILL NC
28754-7606
US

IV. Provider business mailing address

345 MANOR RD
MARS HILL NC
28754-7606
US

V. Phone/Fax

Practice location:
  • Phone: 828-689-5200
  • Fax: 828-689-2729
Mailing address:
  • Phone: 828-689-5200
  • Fax: 828-689-2729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0387870001
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerDMERC
# 2
IdentifierNH0290
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerDFS LICENSE
# 3
Identifier3405206
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 4
Identifier3406224
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: MS. DEBRA A GIEZENTANNER
Title or Position: NURSING HOME ADMINISTRATOR
Credential:
Phone: 828-689-5200