Provider Demographics
NPI:1023002995
Name:WARREN COUNTY HEALTH CARE LLC
Entity Type:Organization
Organization Name:WARREN COUNTY HEALTH CARE LLC
Other - Org Name:WARRENTON HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-465-3328
Mailing Address - Street 1:110 PLANTATION CHASE
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS IS
Mailing Address - State:GA
Mailing Address - Zip Code:31522-1622
Mailing Address - Country:US
Mailing Address - Phone:706-465-3328
Mailing Address - Fax:706-465-1119
Practice Address - Street 1:813 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:GA
Practice Address - Zip Code:30828-9105
Practice Address - Country:US
Practice Address - Phone:706-465-3328
Practice Address - Fax:706-465-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-149-1472314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000142645AMedicaid
115321Medicare Oscar/Certification