COFFEE COUNTY NURSING HOME LLC NPI 1730218702

NPI Information

NPI: 1730218702
Provider Name: COFFEE COUNTY NURSING HOME, LLC

Doing Business As: SHADY ACRES

Classification: Clinic/Center - 261QA0600X
Entity Type: Organization

Specialization: Adult Day Care

Address:
1310 GORDON ST W
DOUGLAS, GA
ZIP 31533
Phone: (912) 384-7811
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COFFEE COUNTY NURSING HOME, LLC is an adult day care clinic center in Douglas, GA. COFFEE COUNTY NURSING HOME, LLC NPI is 1730218702. The provider is registered as an organization entity type.
The provider Is Doing Business As Shady Acres.

The provider's business location address is:

1310 GORDON ST W
DOUGLAS, GA
ZIP 31533-432
Phone: (912) 384-7811
Fax: (912) 384-7695

The provider's authorized official is Kim Sheffield .
The authorized official title is Vp Of Financial Reporting and has the following contact phone number (478) 621-2100.

The enumeration date for this NPI number is 3/5/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA0600X	Clinic/Center	Adult Day Care	1-056-1784	GEORGIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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