MEDICARE: GLYNN COUNTY HEALTHCARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	10631831	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518949007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLYNN COUNTY HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	2255 FREDERICA RD
Second Line	:
City	:	SAINT SIMONS ISLAND
State	:	GA
Zip	:	31522-1910
Country	:	US
Telephone Number	:	912-638-9988
Fax Number	:

Provider Business Practice Location Address
First Line	:	2255 FREDERICA RD
Second Line	:
City	:	SAINT SIMONS ISLAND
State	:	GA
Zip	:	31522-1910
Country	:	US
Telephone Number	:	912-638-9988
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JACQUELINE CRISP
Credential	:
Telephone Number	:	912-638-9988

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	05/14/2025

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