=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396238788
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DUBLIN HEALTH PROPERTIES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2018
-----------------------------------------------------
Last Update Date | 06/11/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 INDUSTRIAL BLVD
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31021-2800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-272-7437
-----------------------------------------------------
Fax | 478-272-2427
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 INDUSTRIAL BLVD
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31021-2800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-272-7437
-----------------------------------------------------
Fax | 478-272-2427
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | MICHAEL E WINGET SR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 478-974-0006
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------