Provider Demographics
NPI:1285634220
Name:RICHMOND NURSING HOME INC
Entity type:Organization
Organization Name:RICHMOND NURSING HOME INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:PENLEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:706-855-1773
Mailing Address - Street 1:820 STEVENS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9251
Mailing Address - Country:US
Mailing Address - Phone:706-860-6622
Mailing Address - Fax:706-860-6532
Practice Address - Street 1:820 STEVENS CREEK RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-9251
Practice Address - Country:US
Practice Address - Phone:706-860-6622
Practice Address - Fax:706-860-6532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00213463AMedicaid
1062280001OtherDME
GA00213463AMedicaid