Provider Demographics
NPI:1992799860
Name:PUTNAM COUNTY HEALTH CARE LLC
Entity type:Organization
Organization Name:PUTNAM COUNTY HEALTH CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAINT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-485-8573
Mailing Address - Street 1:125 SPARTA HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024
Mailing Address - Country:US
Mailing Address - Phone:706-485-8573
Mailing Address - Fax:706-485-8283
Practice Address - Street 1:125 SPARTA HWY
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-6093
Practice Address - Country:US
Practice Address - Phone:706-485-8573
Practice Address - Fax:706-485-8283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-117-1769314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000223473AMedicaid
GA000223473AMedicaid