Provider Demographics
NPI:1124298328
Name:PORTER FIELD HEALTH & REHAB CENTER LLC
Entity type:Organization
Organization Name:PORTER FIELD HEALTH & REHAB CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WINGET
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:478-974-0006
Mailing Address - Street 1:3051 WHITESIDE RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-6209
Mailing Address - Country:US
Mailing Address - Phone:478-788-1421
Mailing Address - Fax:478-781-0987
Practice Address - Street 1:3051 WHITESIDE RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216-6209
Practice Address - Country:US
Practice Address - Phone:478-788-1421
Practice Address - Fax:478-781-0987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-011-1916314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000222582AMedicaid
GA115636Medicare Oscar/Certification