Provider Demographics
NPI:1316914302
Name:ARROWHEAD HEALTHCARE, LLC
Entity type:Organization
Organization Name:ARROWHEAD HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TYGH
Authorized Official - Middle Name:
Authorized Official - Last Name:BROGDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-650-8773
Mailing Address - Street 1:239 ARROWHEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236
Mailing Address - Country:US
Mailing Address - Phone:770-478-3013
Mailing Address - Fax:770-478-3446
Practice Address - Street 1:239 ARROWHEAD BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1101
Practice Address - Country:US
Practice Address - Phone:770-478-3013
Practice Address - Fax:770-478-3446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-031-1598314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00143162AMedicaid
GA11-5539Medicare ID - Type UnspecifiedPROVIDER MEDICARE NUMBER