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General NPI Number Information
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NPI Number | 1558357368
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Entity Type | Organization
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Legal Business Name | MARIETTA HEALTH AND REHABILITATION CENTER, INC.
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 50 SAINE DR SW
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City | MARIETTA
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State | GA
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Zip | 30008-3824
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Country | US
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Telephone | 770-429-8600
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Fax | 770-429-8677
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Provider Business Mailing Address
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Address Line | 50 SAINE DR SW
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City | MARIETTA
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State | GA
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Zip | 30008-3824
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Country | US
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Telephone | 770-429-8600
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Fax | 770-429-8677
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RICHARD EDWARD FALLAW SR.
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Credential |
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Telephone | 229-268-7510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 1-033-1793
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License Number State | GA
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