Provider Demographics
NPI:1487699831
Name:BIBB COUNTY HEALTH CARE LLC
Entity type:Organization
Organization Name:BIBB COUNTY HEALTH CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-477-4464
Mailing Address - Street 1:3468 NAPIER AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-3743
Mailing Address - Country:US
Mailing Address - Phone:478-477-4464
Mailing Address - Fax:478-477-7869
Practice Address - Street 1:3468 NAPIER AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-3743
Practice Address - Country:US
Practice Address - Phone:478-477-4464
Practice Address - Fax:478-477-7869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-011-1861314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
51001076 001OtherBCBS
GA000140236AMedicaid
GA000140236AMedicaid