Provider Demographics
NPI:1427526128
Name:SC-GA2018 COBBLESTONE REHABILITATION AND HEALTHCARE CENTER, LLC
Entity type:Organization
Organization Name:SC-GA2018 COBBLESTONE REHABILITATION AND HEALTHCARE CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-430-0000
Mailing Address - Street 1:103B REGENCY COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-5210
Mailing Address - Country:US
Mailing Address - Phone:864-688-3992
Mailing Address - Fax:
Practice Address - Street 1:101 COBBLESTONE TRCE SE
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31788-7747
Practice Address - Country:US
Practice Address - Phone:229-985-3637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GULF COAST FACILITIES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-12
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility