Provider Demographics
NPI:1972976439
Name:FRANKLIN HEALTHCARE OF PEABODY, LLC
Entity type:Organization
Organization Name:FRANKLIN HEALTHCARE OF PEABODY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:MITTLEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-282-3268
Mailing Address - Street 1:3050 ROYAL BLVD S
Mailing Address - Street 2:STE. 190
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4427
Mailing Address - Country:US
Mailing Address - Phone:470-282-3268
Mailing Address - Fax:470-268-7957
Practice Address - Street 1:500 PEABODY AVE
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:KS
Practice Address - Zip Code:66866-1206
Practice Address - Country:US
Practice Address - Phone:620-983-2165
Practice Address - Fax:620-983-2364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN057002313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1542075301Medicaid