Provider Demographics
NPI:1699764894
Name:PEACHBELT HEALTH AND REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:PEACHBELT HEALTH AND REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-328-3800
Mailing Address - Street 1:801 ELBERTA RD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-1735
Mailing Address - Country:US
Mailing Address - Phone:478-923-3156
Mailing Address - Fax:478-923-9040
Practice Address - Street 1:801 ELBERTA RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-1735
Practice Address - Country:US
Practice Address - Phone:478-923-3156
Practice Address - Fax:478-923-9040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-076-1576314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00142381AMedicaid
GA115552Medicare ID - Type UnspecifiedPROVIDER NUMBER
GA00142381AMedicaid