=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801833231
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LILLIAN G. CARTER NURSING CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2006
-----------------------------------------------------
Last Update Date | 07/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 HOSPITAL ST
-----------------------------------------------------
City | PLAINS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31780-5544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-824-7796
-----------------------------------------------------
Fax | 229-824-7800
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 225 HOSPITAL ST
-----------------------------------------------------
City | PLAINS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31780-5544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-824-7796
-----------------------------------------------------
Fax | 229-824-7800
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | JESSICA SEARCY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 229-824-7796
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 1-129-1714
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------