Provider Demographics
NPI:1811935356
Name:FOUR COUNTY HEALTH CARE LLC
Entity type:Organization
Organization Name:FOUR COUNTY HEALTH CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:METHENY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-887-2021
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31825-0339
Mailing Address - Country:US
Mailing Address - Phone:229-887-2021
Mailing Address - Fax:229-887-3978
Practice Address - Street 1:124 OVERBY DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:GA
Practice Address - Zip Code:31825-1300
Practice Address - Country:US
Practice Address - Phone:229-887-2021
Practice Address - Fax:229-887-3978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-128-1712314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
51001238 001OtherBCBS
GA00405292AMedicaid
115481Medicare Oscar/Certification