Provider Demographics
NPI:1992814644
Name:JONESBORO NURSING AND REHABILITATION CENTER, LLC
Entity type:Organization
Organization Name:JONESBORO NURSING AND REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NORBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-662-4955
Mailing Address - Street 1:2650 HIGHWAY 138 E
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2744
Mailing Address - Country:US
Mailing Address - Phone:770-473-4436
Mailing Address - Fax:770-473-4698
Practice Address - Street 1:2650 HIGHWAY 138 E
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2744
Practice Address - Country:US
Practice Address - Phone:770-473-4436
Practice Address - Fax:770-473-4698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10311772314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00531033AMedicaid
GA115545Medicare Oscar/Certification