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General NPI Number Information
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NPI Number | 1659307957
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Entity Type | Organization
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Legal Business Name | FAYETTE COUNTY NURSING HOME LLC
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 151 WISDOM RD
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-3937
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Country | US
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Telephone | 770-631-9000
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Fax | 770-487-2788
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Provider Business Mailing Address
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Address Line | PO BOX 2747
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-0747
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Country | US
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Telephone | 770-631-9000
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Fax | 770-487-2788
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SHANATHANIA MAHORN
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Credential |
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Telephone | 770-631-9000
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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 | 1-056-1784
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License Number State | GA
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